Rifaximin versus chlortetracycline in the short‐term treatment of small intestinal bacterial overgrowth

Abstract

Rifaximin is a promising, easily-handled and safe drug for the short-term treatment of small intestinal bacterial overgrowth.

Antibiotic treatment of small bowel bacterial overgrowth in patients with Crohn's disease

“…21,22 Our study is the first demonstration of the efficacy of metronidazole and ciprofloxacin in the treatment of small bowel bacterial overgrowth in patients affected by Crohn's disease, even if these drugs have been widely used in the active disease for many years. [11][12][13] In our experience both antibiotics were effective and well tolerated in the treatment of this condition, although ciprofloxacin showed a small, but not statistically significant, gain in terms of efficacy and tolerability compared to metronidazole. Most patients in both study groups presented a normalization of breath test parameters and a significant improvement of symptoms after antibiotic treatment.…”

“…4 The detection of bacterial overgrowth is important in the clinical management of these patients because it can contribute to the worsening of intestinal symptoms (diarrhoea, abdominal pain and bloating) and because it is a treatable condition in most instances. 4,9 Antibiotic therapy of bacterial overgrowth has been studied in patients with several conditions, [9][10][11] while there are no specific data on treatment of bacterial overgrowth complicating Crohn's disease. Metronidazole and ciprofloxacin are two drugs widely used in the treatment of active Crohn's disease, [12][13][14] but their effectiveness in patients with small bowel bacterial overgrowth is not proven.…”

Small intestine bacterial overgrowth and irritable bowel syndrome-related symptoms: Experience with Rifaximin

“…Although the treatment was very short (7 d) and no long-term follow-up available, our data seem to confirm other experiences reported in the most recent literature by Majewski et al [3] that a daily dose of 800 mg Rifaximin for 4 wk significantly reduced the symptoms in 20 patients with IBS and led to a negative BT in almost half of patients. Moreover, in another series of 23 patients with SIBO and positive BT, administration of Rifaximin 1200 mg/d for 7 d followed by treatment with probiotics led to a negative BT in 19 (82.6%) cases and significantly reduced the peak in hydrogen concentrations in the expired air from 40.9 ± 20.4 to 4.78 ± 8.42 ppm [2] ; Rifaximin was also more effective than chlortetracycline in improving symptoms in patients with SIBO and IBS [18] . More evidences on the efficacy of Rifaximin have been reported in patients with SIBO and acute diverticulitis of colon [19] , and patients with SIBO and celiac disease [20] .…”

“…On the other hand, the difficulty in identifying the specific bacterial population and the affected part of the digestive tract by SIBO prevents the possibility of using targeted antibiotics; the recommendation is to use a broad-spectrum antibiotic therapy, capable of eradicating aerobes and anaerobes, preferably with a topical rather than a general action. Valuable alternatives to Rifaximin that have been proven to be effective in the treatment of SIBO are norfloxacin and amoxicillinclavulanic acid [21] , levofloxacin and/or metronidazole [22] , gentamycin [23] , trimethoprim/sulfamerazine and polymyxin [24] , and chlortetracycline [18] .…”

Breath test for differential diagnosis between small intestinal bacterial overgrowth and irritable bowel disease: An observation on non-absorbable antibiotics

“…It should be noted that further treatment with ciprofloxacin -an antibiotic widely used in the treatment of IBS [52,53] has not given significantly better results than rifaximin in our experience. Valuable alternatives to rifaximin that have been proven to be effective in the treatment of SIBO are represented by norfloxacin and amoxicillin-clavulanic acid [54] , gentamycin [55] , trimethoprim/sulfamerazin and polymyxin [56] , and chlortetracycline [57] .…”