Benefits of the Antibiotic Rifaximin as Empiric Therapy in Patients with Irritable Bowel Syndrome
Bibliographic record
Abstract
Purpose: Irritable bowel syndrome (IBS) affects ∼58 million individuals in the United States, and data suggest a possible role for intestinal bacteria in the pathogenesis/clinical symptoms of IBS. Rifaximin (Xifaxan®, Salix Pharmaceuticals, Morrisville, NC) is a nonsystemic (<0.4% absorption), gut-selective, well-tolerated antibiotic with broad-spectrum activity against gram-positive and gram-negative aerobic and anaerobic organisms. Due to limited data available on potential benefits of rifaximin treatment in combination with probiotics in patients with IBS, a retrospective chart review was conducted from November 2004 to September 2005 to identify patients with IBS fulfilling Rome II criteria who were treated with rifaximin. Methods: Eight patients were identified (21 to 73 years of age) with a history of IBS for >1 year. Patients were classified as IBS associated with diarrhea (n = 5) or IBS with alternating diarrhea and constipation (n = 3). Comorbidities included gastroesophageal reflux disease (n = 4), lactose intolerance/peptic ulcer (n = 1), pancreatitis (n = 1), Schatzki's ring (n = 1), and infection with human immunodeficiency virus (n = 1). Previous IBS therapy included probiotics (n = 3) or high-fiber diet (n = 1). Patients were empirically treated with rifaximin 400 mg 3 times daily for a mean of 2.5 months (range, 1 to 5 months) in combination with a probiotic (Flora-Q™, Kenwood Therapeutics, Fairfield, NJ) administered once- (n = 7) or twice-daily (n = 1). Results: Rifaximin use resulted in complete resolution of clinical symptoms in 4 patients, with no IBS relapse (follow-up, 1 to 6 months). Partial symptom improvement was observed in 4 patients, 3 of whom were treated for an additional 2 months with rifaximin 400 mg three times daily cycle therapy (2 weeks on/1 week off; with 1 patient also receiving a probiotic) which resulted in a 50% to 70% improvement from baseline. Rifaximin treatment was well tolerated, with no discontinuations or disruptions in the treatment regimen and no reports of rifaximin-related adverse events. All 8 patients remain on probiotic once daily maintenance therapy. Conclusions: This chart review suggests that some patients with IBS may benefit from rifaximin and probiotic combination therapy. Given the low risk for clinical resistance and positive rifaximin attributes described above, further studies on the potential benefit of this nonsystemic antibiotic for IBS are warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".