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Rifaximin
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Rifaximin has antimicrobial activity against many skin pathogens, and because it is not absorbed transcutaneously, has been used in localized skin infections (Pelosini and Scarpignato, 2005). Randomized controlled studies showed that a 5% topical rifaximin formulation was superior to chlortetracycline, with more rapid improvements of subjective and objective parameters (Pelosini and Scarpignato, 2005). Bacterial eradication occurred in 96.5% patients with rifaximin compared with 79.2% with tetracycline (OR: 6.51; 95% CI: 2.71–15.64, p < 0.0001) (Pelosini and Scarpignato, 2005). There were no associated adverse effects, such as contact dermatitis or photosensitization (Pelosini and Scarpignato, 2005).
Bacteria Causing Gastrointestinal Infections
Published in K. Balamurugan, U. Prithika, Pocket Guide to Bacterial Infections, 2019
B. Vinoth, M. Krishna Raja, B. Agieshkumar
EAEC were first identified during the evaluation of diarrhea in Chilean children in 1987 when E. coli with a specific adherence pattern of stacked-brick appearance was found when compared to controls. Because of the aggregative clumping of the organism to the enterocytes, they are named enteroaggregative E. coli. EAEC causes acute and persistent diarrhea in children and adults in developing and developed countries. They are commonly associated with diarrhea in patients with HIV and also causes traveler’s diarrhea. The major pathogenic factors are its characteristic adherence, production of enterotoxins and cytotoxins, and mucosal inflammation. EAEC adheres to the intestinal epithelial cells by aggregative adherence fimbriae (AAF) in a stacked-brick pattern. The toxins produced by EAEC are Shiga enterotoxin 1 (ShET1), enteroaggregative heat-stable toxin 1 (EAST1), and plasmid encoded toxin termed Pet. ShET1 and EAST1 causes increased conductance across enterocytes leading to ion secretion and subsequent diarrhea. Pet toxin is involved in dissolution of the cytoskeleton of the epithelial cell. EAEC causes mucosal inflammation by inducing the release of IL-8 from the epithelial cells. Diagnosis can be made only by epithelial cell adherence assay with Hep 2 cells to study the stacked-brick appearance or by DNA hybridization or PCR assays to detect specific target genes. The role of antibiotic in EAEC is not well evaluated because of the rarity of its diagnosis. However, antibiotics have been shown to be effective for traveler’s diarrhea and in patients with HIV. The preferred antibiotics are ciprofloxacin, azithromycin, and rifaximin. Rifaximin are particularly useful in traveler’s diarrhea. In developing countries, EAEC produces long-term sequelae like stunted growth and development of IBS.
Treatment strategies, including antibiotics, to target the immune component of rosacea
Published in Expert Review of Clinical Immunology, 2022
Kristen Delans, Katherine Kelly, Steven R. Feldman
Rifaximin is a luminally active, oral antibiotic. Currently, it is a registered treatment for irritable bowel syndrome, traveler’s diarrhea, and hepatic encephalopathy. The drug became a target for investigation in rosacea treatment as associations between rosacea and gastrointestinal pathology became more apparent [53]. The mechanisms by which small intestinal bacterial overgrowth (SIBO) induces a dysregulated immune response may include upregulation of tumor necrosis factor-alpha (TNF-alpha) or other cytokines, suppression of modulatory interleukin-17 (IL-17), and stimulation of the T helper 1-mediated immune response [54,55]. In one study, 46% of rosacea patients were found to have SIBO [54]. This finding prompted researchers to evaluate SIBO as a pathogenic mechanism for the rosacea disease state. After therapy with rifaximin, complete resolution of cutaneous lesions in 78% of the patients with SIBO was observed. A clinical trial started in 2018 is currently in progress with the aim of evaluating rifaximin for safety and efficacy in the treatment of papulopustular rosacea; results are not yet published (Table 2) [,91]. These early findings support that bacterial overgrowth in the small bowel may alter immunity and trigger rosacea in predisposed individuals.
Gut inflammation in CVID: causes and consequences
Published in Expert Review of Clinical Immunology, 2022
As of now, there is only one study in CVID targeting gut microbiota composition. In this study, we used rifaximin a broad-spectrum antibiotic acting locally in the gut, with negligible systemic absorption. Rifaximin is approved for travelers’ diarrhea and is used for prevention of liver encephalopathy (reduce LPS). Rifaximin has been used in CVID enteropathy for small intestine bacterial overgrowth [123], but randomized studies have not been performed. We designed a proof-of-concept study to explore if alteration of the gut microbiota by rifaximin could reduce LSP (increased in CVID) and affect systemic inflammation. We found that, although the microbiota composition was significantly changed by rifaximin, there was no significant change in systemic inflammatory markers or LPS in CVID patients taking rifaximin. The reason for this may be that the important bacteria responsible for the CVID dysbiosis, i.e. the ten taxa in the CVID dysbiosis index, were not changed by rifaximin.
Emerging therapies in the management of Irritable Bowel Syndrome (IBS)
Published in Expert Opinion on Emerging Drugs, 2022
Jill E. Elwing, Hadi Atassi, Benjamin D. Rogers, Gregory S. Sayuk
Rifaximin is a broad-spectrum, minimally absorbed, antibiotic that is FDA approved for IBS-D treatment using a 2-week course of therapy. Rifaximin is presumed to favorably modulate the gut microbiome/metabolome, and accordingly in 2 large, phase 3 trials (TARGET 1&2), rifaximin was demonstrated to lead to adequate relief of global IBS symptoms to a significantly greater level compared to placebo (40.7% vs. 31.7%, pooled P < 0.001) [19]. However, a question of response durability was raised, inspiring TARGET 3, a rifaximin retreatment trial for patients [20]. This study demonstrated rifaximin benefit with retreatment leading to FDA approval for IBS-D treatment, with up to two additional courses of rifaximin as needed for symptom recurrence. Rifaximin is well-tolerated, with minimal side effects and a number needed to harm of 8971 in pooled analysis of the clinical [21]. ACG Guidelines thus offer a strong recommendation for use based on a moderate level of evidence [3].