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Antibiotic therapy in small intestinal bacterial overgrowth: rifaximin versus metronidazole

E C Lauritano1, M Gabrielli, E Scarpellini

  • 1Internal Medicine Department, Catholic University of the Sacred Heart, Rome, Italy.

European Review for Medical and Pharmacological Sciences
|June 9, 2009
PubMed
Abstract

Insights

Rifaximin demonstrated a higher small intestinal bacterial overgrowth (SIBO) decontamination rate and better tolerability compared to metronidazole. This study suggests rifaximin is a favorable option for managing SIBO patients.

Area of Science:

  • Gastroenterology
  • Microbiology
  • Pharmacology

Background:

  • Limited controlled trials exist for antibiotic therapy in small intestinal bacterial overgrowth (SIBO).
  • Assessing the efficacy and safety of SIBO treatments is crucial for patient management.

Purpose of the Study:

  • To compare the efficacy, safety, and tolerability of rifaximin versus metronidazole for treating SIBO.
  • To evaluate the SIBO decontamination rates and adverse event profiles of the two antibiotics.

Main Methods:

  • A randomized controlled trial involving 142 patients diagnosed with SIBO.
  • Patients received either 7-day rifaximin (1200 mg/day) or metronidazole (750 mg/day) treatment.
  • Diagnosis was confirmed by glucose breath test; reassessment occurred one month post-treatment.

Main Results:

  • Rifaximin showed a significantly higher glucose breath test normalization rate (63.4%) compared to metronidazole (43.7%).
  • The overall incidence of adverse events was significantly lower in the rifaximin group.
  • Rifaximin exhibited a higher SIBO decontamination rate than metronidazole.

Conclusions:

  • Rifaximin is more effective and better tolerated than metronidazole for SIBO treatment.
  • These findings support rifaximin as a preferred therapeutic option for managing SIBO.

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