Management of Diarrhea in Patients Taking Rifaximin

Assessment and Management

• The American Gastroenterological Association recommends determining if diarrhea represents worsening of the original condition being treated or a new adverse event in patients taking rifaximin 1, 2
• The assessment should consider the timing of diarrhea onset in relation to rifaximin treatment initiation 2
• For patients with irritable bowel syndrome with diarrhea (IBS-D), retreatment with rifaximin is recommended at the same dosage (550 mg three times daily for 14 days) if symptoms recur after initial response 1, 2
• Patients with IBS-D can be retreated up to 2 additional times with the same dosage regimen 1
• The safety profile of rifaximin is generally favorable, with adverse events similar to placebo in clinical trials, according to the American Gastroenterological Association 2, 5
• Rifaximin may not be effective against invasive enteric pathogens, which may explain treatment failures in some cases of travelers' diarrhea, as noted by the International Society of Travel Medicine 4
• Persistent diarrhea in travelers may indicate an invasive pathogen not adequately covered by rifaximin, requiring different antimicrobial therapy, as recommended by the International Society of Travel Medicine 3, 4