Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2016; 22(29): 6638-6651
Published online Aug 7, 2016. doi: 10.3748/wjg.v22.i29.6638
Use of rifaximin in gastrointestinal and liver diseases
Rani H Shayto, Rachel Abou Mrad, Ala I Sharara
Rani H Shayto, Rachel Abou Mrad, Ala I Sharara, Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: None to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ala I Sharara, MD, FACG, AGAF, Professor, Head, Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Cairo Street, Beirut 11-0236, Lebanon. ala.sharara@aub.edu.lb
Telephone: +961-1-350000-5351 Fax: +961-1-366098
Received: April 18, 2016
Peer-review started: April 19, 2016
First decision: May 27, 2016
Revised: June 17, 2016
Accepted: July 6, 2016
Article in press: July 6, 2016
Published online: August 7, 2016
Abstract

Rifaximin is a broad spectrum oral antibiotic with antimicrobial activity against Gram-positive and Gram-negative aerobic and anaerobic bacteria. It is poorly absorbed and thus has a highly favorable safety profile. Rifaximin has been shown to be effective in the treatment of traveler’s diarrhea, functional bloating and irritable bowel syndrome, small bowel bacterial overgrowth and in the prevention of recurrent overt hepatic encephalopathy. In addition, there is emerging evidence for a possible beneficial effect of rifaximin in the treatment of uncomplicated diverticular disease and in the prevention of recurrent diverticulitis. The use of rifaximin is associated with a low incidence of development, or persistence of spontaneous bacterial mutants. Moreover, the development of important drug resistance among extra-intestinal flora during rifaximin therapy is unlikely because of minimal systemic absorption and limited cross-resistance of rifaximin with other antimicrobials. This review addresses the current and emerging role of rifaximin in the treatment of gastrointestinal and liver disorders.

Keywords: Irritable bowel syndrome, Inflammatory bowel disease, Hepatic encephalopathy, Bacterial overgrowth, Diverticular disease

Core tip: Rifaximin is a poorly absorbed oral antibiotic with highly favorable safety profile. Rifaximin is effective in the treatment of traveler’s diarrhea, functional bloating and irritable bowel syndrome, small bowel bacterial overgrowth and in the prevention of recurrent overt hepatic encephalopathy. There is emerging evidence for a possible beneficial effect of rifaximin in the treatment of other disorders including uncomplicated diverticular disease and in the prevention of recurrent diverticulitis. The use of rifaximin is associated with a low incidence of development of spontaneous bacterial mutants or drug resistance among extra-intestinal flora.