XIFAXAN and bloating

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Antibiotic Relieves Chronic Bloating and Flatulence

By Jeff Minerd, MedPage Today Staff Writer

Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of

Pennsylvania School of Medicine.

February 15, 2006

MedPage Today Action Points

On the basis of this small study, consider discussing with patients the

off-label use of Xifaxan (rifaximin) for short-term treatment of abdominal

bloating and flatulence, especially in patients suffering from irritable bowel

syndrome.

Thanks to Norm for this tip

Review

BEIRUT, Lebanon, Feb. 15 - Chronic abdominal bloating and flatulence may have

salvation in the antibiotic Xifaxan (rifaximin), which is approved in the U.S.

for travelers' diarrhea, researchers here reported.

On the basis of a small randomized double-blind placebo-controlled trial, a

group at the American University of Beirut Medical Center here said the

antibiotic is safe and effective for treating chronic bloating and flatulence

even in patients with irritable bowel syndrome (IBS).

In the double-blind study of 124 patients, half were randomized to 400 mg of

Xifaxan daily for 10 days and half to a placebo, reported Ala I. Sharara, M.D.,

and colleagues in the February issue of the American Journal of

Gastroenterology. In both treatment and the placebo groups, about half the

patients had symptoms severe enough to be classed as IBS.

After 10 days, significantly more patients in the treatment group reported

symptom relief compared with the placebo group (41% versus 23%; P=.03).

The effect was similar when the researchers considered only the patients with

IBS. Forty percent of IBS patients in the treatment group reported symptom

relief compared with 18% of IBS patients in the placebo group (P=.04).

This effect was maintained through an additional 10-day follow-up, during which

29% of patients in the treatment group reported improved symptoms, versus 11.5%

for the placebo arm (P=.04).

In addition, breath testing showed a decrease in hydrogen excretion levels in

the treatment group, suggesting that the antibacterial effect of the drug on gut

flora reduced colonic fermentation, the investigators said.

" Due to the lack of intestinal absorption, rifaximin has no systemic side

effects and is therefore suitable for chronic use, " the authors said. The drug

was FDA-approved in 2004 for the treatment of patients 12 or older with

travelers' diarrhea caused by non-invasive strains of Escherichia coli.

" Further studies are, however, needed to identify the specific colonic flora

associated with these symptoms and the role of probiotics and antibiotics in

this disorder, " the authors concluded.

The authors noted several limitations, including " the somewhat inhomogeneous

patient population (IBS and non-IBS patients), the short duration of therapy and

follow-up, and the relatively small number of patients achieving a positive

response making analysis of predictors of response and relationship to colonic

hydrogen gas production of limited power. "

They added, " The efficacy of long-term or cyclic use of rifaximin, as primary or

adjuvant therapy in this patient population deserves further investigation. "

Primary source: American Journal of Gastroenterology

Source reference:

Sharara AI et al. A randomized double-blind placebo-controlled trial of

rifaximin in patients with abdominal bloating and flatulence. American Journal

of Gastroenterology. 2006; 101(2):326-333.

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