(2007-Scarpellini)High dosage rifaximin for the treatment of small intestinal bacterial overgrowth.pdf

High dosage rifaximin for the treatment of small intestinal bacterial overgrowth E. SCARPELLINI , M. GABRIELLI , C . E . LAURITANO, A. LUPASCU, G. MERRA, G. CAMMAROTA, I . A . CAZZATO, G. GASBARRINI A. GASBARRINI Internal Medicine Department, Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy Correspondence to: Dr. A. Gasbarrini, Internal Medicine and Angiology, Catholic University of Sacred Heart, Gemelli Hospital, Largo A. Gemelli, 8; 00168 Rome, Italy. E-mail: angiologia@rm.unicatt.it Publication data Submitted 12 October 2006 First decision 30 October 2006 Resubmitted 3 January 2007 Accepted 15 January 2007 SUMMARY Background Rifaximin is a broad spectrum non-absorbable antibiotic used for treat- ment of small intestinal bacterial overgrowth. Doses of 1200 mg ?day showed a decontamination rate of 60% with low side-effects incidence. Aims To assess efficacy, safety and tolerability of rifaximin 1600 mg with respect to 1200 mg ?day for small intestinal bacterial overgrowth treat- ment. Methods Eighty consecutive small intestinal bacterial overgrowth patients were enrolled. Diagnosis of small intestinal bacterial overgrowth based the clinical history and positivity to H2 ?CH4 glucose breath test. Patients were randomized in two 7-day treatment groups: rifaximin 1600 mg (group 1); rifaximin 1200 mg (group 2). Glucose breath test was reas- sessed 1 month after. Compliance and side-effect incidence were also evaluated. Results One drop-out was observed in group 1 and two in group 2. Glucose breath test normalization rate was significantly higher in group 1 with respect to group 2 both in intention-to-treat (80% vs. 58%; P 0.05) and per protocol analysis (82% vs. 61%; P 0.05). No significant differ- ences in patient compliance and incidence of side effects were found between groups. Conclusions Rifaximin 1600 mg ?day showed a significantly higher efficacy for small intestinal bacterial overgrowth treatment with respect to 1200 mg with similar complia