Rifaximine

Rifaximin, sold under the trade name Xifaxan among others, is an antibiotic used to treat traveler's diarrhea, irritable bowel syndrome, and hepatic encephalopathy. It has poor absorption when taken by mouth. Rifaximin, sold under the trade name Xifaxan among others, is an antibiotic used to treat traveler's diarrhea, irritable bowel syndrome, and hepatic encephalopathy. It has poor absorption when taken by mouth. It is based on rifamycin. Rifaximin was approved for medical use in the United States in 2004. In the United States it costs US$62.13 per day for 1100 mg of rifaximin ($1,864.00 per month) as of January 2017. In Russia as of 2016 a similar dose costs 231.25 RUB (approximately US$4), Colombia as 2019, 1100mg (2 tabs - 550mg) costs 6286 COP (approximately US $2). Rifaximin may be used to treat and prevent traveler's diarrhea. Rifaximin is approved in the United States for the treatment of irritable bowel syndrome. It possesses anti-inflammatory and antibacterial properties and additionally, it is a nonabsorbable antibiotic that acts locally in the gut. These properties make it efficacious in relieving chronic functional symptoms of non-constipation type irritable bowel syndrome (IBS). It appears to retain its therapeutic properties for this indication, even after repeated courses. Rifaximin is particularly indicated where small intestine bacterial overgrowth is suspected of involvement in a person's IBS. Symptom relief or improvement can be obtained for global IBS symptoms including: abdominal pain, flatulence, bloating, and stool consistency. A drawback is that repeated courses may be necessary for relapse of symptoms. There is evidence that rifaximin can be curative in some people with IBS. Rifaximin may also be a useful addition to vancomycin when treating patients with relapsing C. difficile infection. However the quality of evidence of these studies was judged to be low. Although exposure to rifamycins in the past may increase risk for resistance, so rifaximin should be avoided in such cases. In the United States, rifaximin has orphan drug status for the treatment of hepatic encephalopathy. Although high-quality evidence is still lacking, rifaximin appears to be as effective as or more effective than other available treatments for hepatic encephalopathy (such as lactulose), is better tolerated, and may work faster. Rifaximin is taken by mouth. It has minimal side effects, prevents reoccurring encephalopathy, and is associated with high patient satisfaction. People are more compliant and satisfied to take this medication than any other due to minimal side effects, prolonged remission, and overall cost. It reduces the levels of intestinal ammonia-producing bacteria thus alleviating the symptoms of hepatic encephalopathy and reducing mortality. The drawbacks to rifaximin are increased cost and lack of robust clinical trials for HE without combination lactulose therapy. Other uses include treatment of: infectious diarrhea, small intestinal bacterial overgrowth, inflammatory bowel disease, and diverticular disease. Rifaximin is effective in treating small intestinal bacterial overgrowth regardless of whether it is associated with irritable bowel syndrome or not. Cautious use is required in individuals with cirrhosis of the liver who have a Child-Pugh score of class C severity. Rifaximin has few side effects. Side effects are generally mild and uncommon; this is largely because very little of the drug is absorbed from the gut meaning systemic side effects are absent. Clostridium difficile infection does not typically result from rifaximin therapy unless risk factors such as immunosuppression and hospitalisation are present. Rifaximin is active against Clostridium difficile.