Rifaximin Use in Clinical Practice

Indications and Efficacy

The American Gastroenterological Association recommends Rifaximin (200 mg three times daily for 3 days) for treating travelers' diarrhea caused by non-invasive diarrheagenic Escherichia coli 1
Rifaximin should NOT be used for travelers' diarrhea in areas where invasive pathogens are common due to limited efficacy against these organisms 1
The FDA approves Rifaximin for Irritable Bowel Syndrome with Diarrhea (IBS-D) at a dosage of 550 mg three times daily for 14 days 2, 3, 4
Patients with IBS-D who experience recurrence of symptoms after initial response can be retreated up to 2 times with the same dosage regimen 2, 3, 4
Rifaximin showed significantly greater response based on the FDA responder endpoint for IBS-D compared to placebo (RR, 0.85; 95% CI, 0.78–0.94) 3
Rifaximin demonstrated improvement in relief of bloating (RR, 0.86; 95% CI, 0.70–0.93) and abdominal pain (RR, 0.87; 95% CI, 0.80–0.95) in IBS-D patients 3

The European Association for the Study of the Liver recommends Rifaximin (550 mg twice daily) as an add-on therapy to lactulose for prevention of recurrent hepatic encephalopathy in cirrhotic patients 5, 6
Rifaximin reduced the risk of recurrent hepatic encephalopathy by 58% compared to placebo when added to lactulose therapy 6
Rifaximin should be used alone for prevention of recurrent hepatic encephalopathy only when lactulose is poorly tolerated 6
First-line treatment for acute hepatic encephalopathy remains lactulose, with rifaximin added if lactulose alone fails in prevention 5, 6

The Journal of Travel Medicine recommends rifaximin for treatment of travelers' diarrhea caused by non-invasive diarrheagenic Escherichia coli, with comparable efficacy to fluoroquinolones 7, 8
Rifaximin is not recommended for areas where invasive pathogens are common due to limited efficacy against these organisms, with treatment failure rates up to 50% 7, 9
The Journal of Travel Medicine advises against using rifaximin for treatment of dysentery regardless of illness severity, and for febrile invasive diarrheal disease 7, 9
Rifaximin prophylaxis has only moderate protective effectiveness in South and Southeast Asia where Campylobacteriosis is more common 10

The Journal of Travel Medicine notes that rifaximin has an excellent safety profile due to minimal systemic absorption, with the best safety profile compared to other first-line antibiotics used for travelers' diarrhea 7

For covert hepatic encephalopathy, treatment with lactulose or rifaximin is suggested to improve quality of life and reduce risk of overt hepatic encephalopathy 11