Rifaximin 550mg tablets

This systematic review aimed to compare the clinical efficacy of rifaximin versus lactulose in the management of hepatic encephalopathy (HE) by analyzing evidence from randomized controlled trials (RCTs). A comprehensive search across major databases identified seven eligible RCTs encompassing 693 adult patients diagnosed with overt or minimal HE. Findings demonstrated that rifaximin is at least as effective as lactulose in reversing HE symptoms, with some studies reporting significantly higher HE reversal rates when rifaximin was used in combination with lactulose (e.g., 76% vs. 50.8%, ppp=0.001). While other trials reported similar efficacy between the two agents (e.g., HE improvement: 84.4% vs. 95.4%, p=0.315), rifaximin was generally associated with better tolerability and fewer gastrointestinal side effects. These results support rifaximin as an effective and well-tolerated therapeutic option, either as monotherapy or in combination with lactulose. Further large-scale, multicenter trials are warranted to assess long-term outcomes, recurrence rates, and cost-effectiveness.

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BackgroundSmall intestinal bacterial overgrowth (SIBO) and irritable bowel syndrome (IBS) are common gastrointestinal disorders that significantly impact patients' quality of life and pose a financial burden on healthcare systems. SIBO is characterized by an abnormal increase in small intestinal bacteria, leading to symptoms such as malabsorption, diarrhea, bloating, and abdominal pain. IBS is a functional gastrointestinal disorder marked by recurrent abdominal pain with changes in bowel habits, and is subclassified into diarrhea-predominant IBS (IBS-D), constipation-predominant IBS (IBS-C), and mixed-type IBS. Notably, SIBO and IBS-particularly IBS-D-often present with overlapping symptoms. Antibiotics such as Metronidazole, Bismuth, and Rifaximin are commonly used to treat both conditions; however, their comparative efficacy and safety remain unclear.AimTo analyze and compare the role of Metronidazole, Bismuth, Rifaximin for improvement of SIBO and IBS.MethodsA systematic review was performed on the databases PubMed and Cochrane Library, spanning from 2000 to 2023. Studies eligible for inclusion were observational studies or randomized controlled trials (RCTs) performed on human subjects that examined the use of Metronidazole, Bismuth, or Rifaximin in the management of SIBO and IBS. Two independent reviewers performed data extraction, and resolved discrepancies by consensus. The data extracted consisted study characteristics, patient demographics, intervention details, and outcome measured. Key references were verified and prioritized using Reference Citation Analysis to ensure contemporary relevance and citation impact.ResultsA total of 55 studies, including RCTs and observational studies, met inclusion criteria and were analyzed. These studies assessed the efficacy and safety of Metronidazole, Bismuth, and Rifaximin in patients with SIBO and IBS. Rifaximin demonstrated the most consistent efficacy across both conditions, particularly in IBS-D and mild to moderate SIBO, with a low incidence of adverse events (16.7%). Metronidazole showed moderate efficacy, with some benefit in IBS-C and mild SIBO, but was associated with a higher rate of gastrointestinal side effects (16.6%). Bismuth offered symptom relief in IBS, especially for bloating and diarrhea, though its effectiveness was generally lower than the other agents. Subgroup analyses suggested differential efficacy by IBS subtype and SIBO severity, supporting the potential role of clinical phenotype in guiding antibiotic selection.ConclusionSignificant clinical efficacy was shown by the drug Rifaximin among IBS-D patients at reducing symptoms, with minimal undesirable adverse effects and a favorable safety profile. Metronidazole was effective in treating SIBO but was generally associated with a higher prevalence of gastrointestinal side effects than the other drugs. However, Bismuth generally proved to be effective on isolated levels, especially in combination regimes where it showed its efficacy levels to be less pronounced relative to Rifaximin as well as Metronidazole. Further studies are needed to optimize treatment strategies and clarify the comparative long-term benefits and risks of these therapies.

Abstract licence: CC BY-NC

BackgroundRecurrent acute diverticulitis (RAD) affects up to one-third of patients after the first episode and is associated with impaired quality of life and increased healthcare burden. Although interest in pharmacological prophylaxis is increasing, adequately powered randomized trials have not shown consistent benefits for any agent.AimsSynthesize current evidence on pharmacological strategies for secondary prevention of diverticulitis, evaluate the potential of risk stratification and propose an exploratory framework to inform future studies.MethodsWe conducted a structured narrative review in accordance with the SANRA criteria, including randomized controlled trials, observational studies, systematic reviews and international guidelines published between 1995 and 2026. Studies on primary prevention or symptomatic uncomplicated diverticular disease (SUDD) were assessed separately as indirect evidence.ResultsAlthough subgroup analyses have suggested possible benefits in selected high-risk populations, large randomized trials have not demonstrated a reduction in recurrence with mesalazine or rifaximin. Evidence regarding probiotics remains inconclusive and is largely limited to SUDD. Currently, the major international guidelines do not recommend the use of pharmacological agents for routine secondary prevention. Emerging data indicate that radiologic features, endoscopic severity (DICA score), and biomarker findings, may help identify patients at increased risk of recurrence.ConclusionsCurrently, no pharmacological therapy is available for the universal secondary prevention of diverticulitis. We propose a hypothesis-generating, risk-stratified framework that integrates clinical, endoscopic and radiological markers to support individualized trial design and patient selection. This approach may help guide future randomized studies and refine the preventive strategies.

Abstract licence: CC BY