Efficacy of rifaximin in treating with small intestine bacterial overgrowth: a systematic review and meta-analysis

ABSTRACT

Objectives

Over the past decades, rifaximin has been used to treat with small intestinal bacterial overgrowth (SIBO), however, the true efficacy remains unknown. This systematic review and meta-analysis was performed to assess the safety and efficacy of rifaximin in treating with patients with SIBO.

Methods

Embase, Pubmed, Cochrane Central Register of Controlled Trials, and Web of Science were searched from inception to April, 2021 for published randomized controlled trials (RCTs) and observational studies with or without comparable arms.

Results

A total of 21 observational studies and 5 RCTs involving 874 patients were included. The overall eradication rate according to intention-to-treat analysis (ITT) was 59% (95% CI: 50 to 69%; I² = 90.69%) and to per protocol analysis (PP) 63% (95% CI: 53 to 72%; I² = 90.32%). For 5 RCTs included comparing the efficacy between rifaximin and placebo or active controls, there was no significant difference (n = 203, risk ratio = 1.14, 95%CI: 0.59 to 2.19, P = 0.15, I² = 38%). Subgroup analysis and meta-regression indicated a dose-dependent eradication rate of rifaximin for SIBO.

Conclusion

Rifaximin is effective and safe in eradicating SIBO, with a dose-dependent efficacy and commonly associated with the improvement of the gastrointestinal symptoms and underlying diseases.

KEYWORDS:

• Rifaximin
• small intestine bacterial overgrowth
• systematic review
• meta-analysis
• eradication

Funding

This paper was not funded.

Article highlights

• Overall eradication rate of rifaximin for SIBO is 60% approximately;

• Efficacy of rifaximin in treating with SIBO is dose-dependent, with 1600 mg/day for 1 week having the highest eradication rate;

• Different treatment durations have no significant effect on the efficacy of rifaximin in eradicating SIBO;

• Rifaximin is commonly well tolerated, and a limited number of mild adverse events were reported;

• Efficacy of rifaximin in improving the underlying diseases and gastrointestinal symptoms remains controversial.

Acknowledgments

The authors wish to acknowledge all contributors who do not meet the criteria for authorship.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this manuscript has a consulting agreement and grant from Bausch Health. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Supplementary material

Supplemental data for this article can be accessed here.