title: Rifaximin for the treatment of irritable bowel syndrome - a drug safety evaluation.
abstract: BACKGROUND
  Irritable bowel syndrome is a functional gastrointestinal disorder with a multifactorial etiology. Alterations of intestinal motility and immunity, gut-brain interactions, as well as gut microbiota dysbiosis contribute to the development of irritable bowel syndrome. Therefore, gut microbiota modulation by non-absorbable antibiotics is a therapeutic option in patients with IBS.
  
  
  METHODS
  Published articles including patients with irritable bowel syndrome reporting data about rifaximin activity and safety have been searched throughout the literature and selected.
  
  
  CONCLUSIONS
  The optimal antibiotic molecule should be local-acting, long-acting and safe-acting. Rifaximin is a non-absorbable antibiotic with additional anti-inflammatory and gut microbiota-modulating activity. It is effective in inducing symptoms relief in patients with IBS, even after repeated treatment courses. Rifaximin-related side effects in patients with IBS are reported to be mild and infrequent; microbial resistance is rare and transient, due to the high local concentration of the drug and to the absence of horizontal transmission. Clostridium difficile infection is not usual in patients receiving rifaximin in absence of predisposing conditions such as hospitalization and immunosuppression, which are uncommon in patients affected by irritable bowel syndrome. Nevertheless rifaximin is an antibiotic active against Clostridium difficile infection. Rifaximin has limited metabolic interactions and is not expected to interfere with drug metabolism in patients with normal hepatic function. These properties make rifaximin a safe antibiotic for gut microbiota modulation in patients with IBS.
authors.affiliation: a Internal Medicine and Gastroenterology Division , A. Gemelli Hospital Rome , Rome , Italy.
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: Ponziani
authors.affiliation: a Internal Medicine and Gastroenterology Division , A. Gemelli Hospital Rome , Rome , Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Pecere
authors.affiliation: a Internal Medicine and Gastroenterology Division , A. Gemelli Hospital Rome , Rome , Italy.
authors.forename: Loris
authors.initials: L
authors.lastname: Lopetuso
authors.affiliation: a Internal Medicine and Gastroenterology Division , A. Gemelli Hospital Rome , Rome , Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Scaldaferri
authors.affiliation: a Internal Medicine and Gastroenterology Division , A. Gemelli Hospital Rome , Rome , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cammarota
authors.affiliation: a Internal Medicine and Gastroenterology Division , A. Gemelli Hospital Rome , Rome , Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
mesh_terms: D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000069196:Gastrointestinal Microbiome; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D012294:Rifamycins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000078262:Rifaximin; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D005765:Gastrointestinal Agents; D012294:Rifamycins; D000078262:Rifaximin
keywords: IBS; gut barrier; gut microbiota; rifaximin; safety