title: Rifaximin versus chlortetracycline in the short-term treatment of small intestinal bacterial overgrowth.
abstract: BACKGROUND
  Bacterial overgrowth of the small intestine is a condition characterized by nutrient malabsorption due to an excessive number of bacteria in the lumen of the small intestine. Current treatment is based on empirical courses of broad spectrum antibiotics; few controlled data, with respect to the duration and choice of antibiotic drug, exist at present. The recent availability of rifaximin, a non-absorbable rifamycin derivative, highly effective against anaerobic bacteria, prompted us to carry out a randomized, double-blind controlled trial in order to compare its efficacy and tolerability to those of tetracycline, currently considered the first-choice drug.
  
  
  METHODS
  In 21 patients affected by small intestinal bacterial overgrowth, fasting, peak and total H2 excretion after ingestion of 50 g glucose and severity of symptoms were evaluated before and after a 7-day course of rifaximin, 1200 mg/day (400 mg t.d.s.), or chlortetracycline, 1 g/day (333 mg t.d.s. ).
  
  
  RESULTS
  Fasting, peak and total H2 excretion decreased significantly in the group of patients treated with rifaximin whereas chlortetracycline did not modify these parameters. The H2 breath test normalized in 70% of patients after rifaximin and in 27% of patients after chlortetracycline. The improvement in symptoms was significantly higher in patients treated with rifaximin.
  
  
  CONCLUSIONS
  Rifaximin is a promising, easily-handled and safe drug for the short-term treatment of small intestinal bacterial overgrowth.
authors.affiliation: Gastroenterology Unit, IRCCS 'S. Matteo' Hospital, University of Pavia, Pavia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Di Stefano
authors.forename: S
authors.initials: S
authors.lastname: Malservisi
authors.forename: G
authors.initials: G
authors.lastname: Veneto
authors.forename: A
authors.initials: A
authors.lastname: Ferrieri
authors.forename: G R
authors.initials: GR
authors.lastname: Corazza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D001944:Breath Tests; D002751:Chlortetracycline / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D006859:Hydrogen / Q000032:analysis; D007421:Intestine, Small / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D012294:Rifamycins / Q000627:therapeutic use*; D000078262:Rifaximin; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005765:Gastrointestinal Agents; D012294:Rifamycins; D006859:Hydrogen; D000078262:Rifaximin; D002751:Chlortetracycline