Non‐absorbable antibiotics for managing intestinal gas production and gas‐related symptoms

Abstract

Background: Simethicone, activated charcoal and antimicrobial drugs have been used to treat gas‐related symptoms with conflicting results. Aim: To study the relationship between gaseous symptoms and colonic gas production and to test the efficacy of rifaximin, a new non‐absorbable antimicrobial agent, on these symptoms. Methods: Intestinal gas production was measured by hydrogen (H2) and methane (CH4) breath testing after lactulose in 21 healthy volunteers and 34 functional patients. Only the 34 functional patients took part in a double‐blind, double‐dummy controlled trial, receiving, at random, rifaximin (400 mg b.d per 7 days), or activated charcoal (400 mg b.d per 7 days). The following parameters were evaluated at the start of the study and 1 and 10 days after therapy: bloating, abdominal pain, number of flatus episodes, abdominal girth, and cumulative breath H2 excretion. Results: Hydrogen excretion was greater in functional patients than in healthy volunteers. Rifaximin, but not activated charcoal, led to a significant reduction in H2 excretion and overall severity of symptoms. In particular, in patients treated with rifaximin, a significant reduction in the mean number of flatus episodes and of mean abdominal girth was evident. Conclusions: In patients with gas‐related symptoms the colonic production of H2 is increased. Rifaximin significantly reduces this production and the excessive number of flatus episodes.

Gastrointestinal bacterial overgrowth: pathogenesis and clinical significance

“…Rifaximin has gained popularity since it is nonabsorbed, has few side effects and little evidence for resistance [Frissora and Cash, 2007;Koo and Dupont, 2010]. Rifaximin may therefore be the antibiotic of choice as clinical resistance is seen far less frequent than with other antibiotics [Vanderhoof et al 1998;Yang et al 2008;Rabenstein et al 2011;Di Stefano et al 2000].…”

Rifaximin Is a Gut-Specific Human Pregnane X Receptor Activator

“…Several recent clinical trails have recommended the use of RIFax for prevention of the main complications in patients with diverticular disease (Latella et al, 2003;Pistoia et al, 2004;Papi et al, 2005). In patients with gasrelated symptoms, the colonic production of H 2 is increased, and RIFax significantly reduces this production and the excessive number of flatus episodes (Di Stefano et al, 2000). A combination of RIFax and ciprofloxacin was effective in patients with active chronic, treatment-resistant pouchitis (Gionchetti et al, 1999;Abdelrazeq et al, 2005).…”

Pharmacological Treatment of the Irritable Bowel Syndrome and Other Functional Bowel Disorders

“…Pancreatic enzymes reduced bloating after a high-fat meal and until bedtime in healthy subjects [60], but there are no solid data to this respect in patients with FBD. Antibiotics are not always effective, but it has been shown that the non-absorbable antibiotic rifaximin is able to reduce gas-related symptoms [61]. Regarding probiotics, it is to mention that the administration of Lactobacillus plantarum was followed by an improvement in bloating and reduction of abdominal girth in patients with IBS [62].…”