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Therapeutics
Randomised controlled trial
Two weeks of rifaximin relieves global symptoms and bloating in people with IBS without constipation
  1. Brennan Spiegel
  1. West Los Angeles VA Medical Center, David Geffen School of Medicine, University of California, Los Angeles, California, USA
  1. Correspondence to Brennan Spiegel
    11301 Wilshire Blvd, Building 115, Room 215, Los Angeles, CA 90073, USA; bspiegel{at}mednet.ucla.edu

https://doi.org/10.1136/ebm1404

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    Commentary on: Pimentel M, Lembo A, Chey WD, et al.; TARGET Study Group. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med 2011;364:22–32.OpenUrlCrossRefPubMedWeb of Science

    Context

    Although some studies indicate that small intestinal bacterial overgrowth (SIBO) is prevalent in irritable bowel syndrome (IBS), it remains unclear whether SIBO causes IBS. The poorly absorbed, gut-specific antibiotic, rifaximin, may be well suited to treat SIBO in IBS.

    Methods

    The TARGET study combines data from a pair of large, well-designed, phase III registration trials in 1260 IBS patients with mild-to-moderate, non-constipating symptoms. Patients were randomised to receive either rifaximin, 550 mg three times daily for 2 weeks, or placebo. There was no effort to test for SIBO before treatment, which was initiated empirically. The main outcome measure was improvement in global IBS symptoms as determined using a binary assessment. Secondary outcomes included improvement in individual IBS symptoms, such as bloating, abdominal pain and stool consistency. Measurements of efficacy were made over a 4-week period following treatment.

    Findings

    Significantly, more patients in the rifaximin arms achieved adequate relief …

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    Footnotes

    • Competing interests BS has received grants from Takeda, Prometheus, Movetis. Advisor for Salix, Prometheus, Ironwood, Movetis, AstraZeneca.