Rifaximin dose-finding study for the treatment of small intestinal bacterial overgrowth


Dr A. Gasbarrini, Internal Medicine and Angiology, Catholic University of Sacred Heart, Gemelli Hospital, Largo A. Gemelli, 8; 00168 Rome, Italy.
E-mail: angiologia@rm.unicatt.it


Background : Few controlled studies assessing choice and duration of antibiotic therapy for small intestinal bacterial overgrowth are available.

Aim : To assess efficacy, safety and tolerability of different doses of rifaximin, a broad spectrum non-absorbable antibiotic, for intestinal bacterial overgrowth eradication.

Methods : We enrolled 90 consecutive patients affected by small intestinal bacterial overgrowth. The presence of small intestinal bacterial overgrowth was based on the occurrence of a rise of H2 values >12 p.p.m. above the basal value after 50 g glucose ingestion. Patients were randomized in three 7-day treatment groups: rifaximin 600 mg/day (group 1); rifaximin 800 mg/day (group 2) and rifaximin 1200 mg/day (group 3). Glucose breath test was reassessed 1 month after the end of therapy. Compliance to the treatment and incidence of side-effects were also evaluated.

Results : No drop-outs were observed in the three groups. Glucose breath test normalization rate was significantly higher in group 3 (60%) with respect to group 1 (17%; P < 0.001) and group 2 (27%, P < 0.01). No significant differences in patient compliance and incidence of side-effects were found among groups.

Conclusions : Higher doses of rifaximin lead to a significant gain in terms of therapeutic efficacy in small intestinal bacterial overgrowth eradication without increasing the incidence of side-effects.