Small intestinal bacterial overgrowth is a heterogeneous syndrome, characterized by an increased number and/or abnormal type of bacteria in the small bowel.
Over the past decades, rifaximin has gained popularity for this indication despite its use is not evidence based.
Drs Gatta and Scarpignato from Italy performed a systematic review and meta-analysis to summarize evidence about the efficacy and safety of rifaximin to eradicate small intestine bacterial overgrowth in adult patients.
MEDLINE, EMBASE, CCRCT, Scopus and Web of Science were searched from inception to 2015 for randomized controlled trials, and observational studies.
Furthermore, abstract books of major European, American and Asian gastroenterological meetings were also examined.
|The overall rate of adverse events was 5%|
|Alimentary Pharmacology & Therapeutics|
The team included 32 studies involving 1331 patients.
The overall eradication rate according to intention-to-treat analysis was 72%, and to per protocol analysis 73%.
The researchers identified 3 covariates independently associated with an increased eradication rate.
The team found that the overall rate of adverse events was 5%.
In the subset of studies allowing the analysis, improvement or resolution of symptoms in patients with eradicated small intestine bacterial overgrowth was found to be 68%.
Dr Gatta and colleague commented, "Rifaximin treatment seems to be effective and safe for the treatment of small intestine bacterial overgrowth."
"However, the quality of the available studies is generally poor."
"Well-designed randomized controlled trials are needed to substantiate these findings, and to establish the optimal regimen."