Rifaximin: a nonabsorbable rifamycin antibiotic for use in nonsystemic gastrointestinal infections

Abstract

Rifaximin is a poorly water-soluble and minimally absorbed (<0.4%) rifamycin with in vitro activity against enteric Gram-negative bacteria including enteric pathogens. Fecal levels of the drug after 3 days' oral therapy exceed 8000 microg/g. Rifaximin is effective in the treatment and prevention of travelers' diarrhea due to Escherichia coli-predominant bacterial pathogens. It shows lower activity against dysenteric forms of bacterial diarrhea. The drug may be useful in other enteric infectious diseases, including Clostridium difficile colitis, pediatric bacterial diarrhea and Helicobacter pylori gastritis and chronic gastrointestinal disorders including hepatic encephalopathy, small bowel bacterial overgrowth, inflammatory-bowel disease, irritable-bowel syndrome and pouchitis. Importantly, rifaximin does not appear to lead to bacterial resistance. Rifaximin has an excellent safety profile and adverse drug reactions have been comparable to those associated with the placebo control agent.

Pregnane-X-receptor mediates the anti-inflammatory activities of rifaximin on detoxification pathways in intestinal epithelial cells

“…Rifaximin is a poorly absorbed oral antimicrobial agent that is concentrated in the gastrointestinal tract [33][34][35]. Rifaximin has a broad-spectrum of activity against gram-positive and gram-negative aerobic and anaerobic enteric bacteria [36][37][38].…”

Clostridium difficile-associated disease in human stem cell transplant recipients: coming epidemic or false alarm?

“…4,[35][36][37][38][39][40] Each of these drugs is approved in the United States for other types of gastrointestinal infections, and some clinicians have used either alone or in combination with metronidazole or vancomycin in patients with severe or recalcitrant CDAD. There are several small case reports addressing the potential efficacy of using adjuvant agents such as i.v.…”

“…Newer approaches include long, tapered or pulsed courses of vancomycin, as well as combination or sequential dosing with either rifaximin or nitazoxanide. [1][2][3][4][5]30,[35][36][37][38][39][40][41][42][43] An algorithm outlining our own approach is shown in Figure 2.…”

Role of Rifaximin for the Treatment of Hepatic Encephalopathy in Chronic Liver Disease

“…15 On the other hand, rifaximin is a poorlyabsorbed broad spectrum antibiotic with very few systemic side effects and at low risk of inducing bacterial resistance. 16,17 These properties make rifaximin an ideal antibiotic for the treatment of patients with HE as several studies have shown a significant decrease in plasma ammonia levels [18][19][20] with minimal impact on the normal gastrointestinal flora. 16 Many small studies have suggested that rifaximin is effective in treating acute HE and is extremely well tolerated.…”