title: Rifaximin for small intestinal bacterial overgrowth in patients without irritable bowel syndrome.
abstract: BACKGROUND
  Rifaximin is a minimally absorbed antibiotic with high luminal activity, used to treat various gastrointestinal diseases. Although rifaximin has been proposed as first line treatment for small intestinal bacterial overgrowth (SIBO), few data are available regarding its efficacy in non-IBS subjects. We aimed to assess the ability of rifaximin to normalize lactulose-H2 breath tests in non-IBS subjects with symptoms suggestive of SIBO.
  
  
  METHODS
  Consecutive non-IBS patients presenting with bloating and flatulence were prospectively recruited and submitted to lactulose-H2 breath testing (LBT). Patients who had a positive result were offered rifaximin 1200 mg daily for 10 days. Breath testing was repeated two weeks after treatment completion in all patients in order to assess for response.
  
  
  RESULTS
  A total of 19 patients with a positive result received rifaximin and repeated the breath test (7 (36.8%) males, age 56.5 ± 17.6 years). The mean peak hydrogen excretion was 13.7 ± 2.8 and 10.3 ± 7.3 ppm at baseline and following rifaximin treatment, respectively (t = 1.98, p = 0.06). LBT normalized in 8/19 (42.1%) subjects. No patients reported symptom resolution. No adverse events were reported.
  
  
  CONCLUSIONS
  Strengths include the study's prospective design. Limitations include the small sample size and open label design.
  
  
  CONCLUSIONS
  Rifaximin was not effective in normalizing LBT in our cohort of non-IBS subjects with symptoms suggestive of SIBO.
authors.affiliation: The Neurogastroenterology Service, Department of Gastroenterology, Rabin Medical Center, Beilinson Campus and Sackler Faculty of Medicine, Tel Aviv University, 39 Jabotinski Street, Petah Tikva 49100, Israel. dboltin@gmail.com.
authors.forename: Doron
authors.initials: D
authors.lastname: Boltin
authors.forename: Tsachi Tsadok
authors.initials: TT
authors.lastname: Perets
authors.forename: Einav
authors.initials: E
authors.lastname: Shporn
authors.forename: Shoshana
authors.initials: S
authors.lastname: Aizic
authors.forename: Sigal
authors.initials: S
authors.lastname: Levy
authors.forename: Yaron
authors.initials: Y
authors.lastname: Niv
authors.forename: Ram
authors.initials: R
authors.lastname: Dickman
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001944:Breath Tests; D015331:Cohort Studies; D064806:Dysbiosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000382:microbiology*; D043183:Irritable Bowel Syndrome; D007792:Lactulose / Q000032:analysis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012294:Rifamycins / Q000627:therapeutic use*; D000078262:Rifaximin; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D012294:Rifamycins; D007792:Lactulose; D000078262:Rifaximin