Dysbiosis in the small intestine: towards an optimal therapy to normalize the gut microbiota

Abstract

Objectives: Rifaximin seems to be effective and safe in treating small intestinal bacterial overgrowth (SIBO), however, to date there is no consensus regarding the proper timing of therapy. The present study aims to provide preliminary data regarding the effects of rifaximin (600 mg/day for five days) in patients with SIBO. Patients and Methods: We retrospectively analysed clinical records and baseline lactulose breath tests of 15 otherwise healthy patients with an established diagnosis of SIBO. 7 subjects were treated with rifaximin at the daily dose of 600 mg/day for 5 days per month (group 1). The other 8 subjects were treated with the same daily dose of Rifaximin, but for two monthly cycles of 5 days each (group 2). All the patients repeated the breath test after one month. The results of the breath tests performed at the baseline and after a month were compared to determine whether the different dosage of the therapy had had different effects. Results: Comparing the results of breath tests performed at baseline and after one month, we found a significant lowering in expired H2 levels in patients who received rifaximin in two monthly cycles, while expired H2 levels remained stable in patients treated with only one monthly cycle of rifaximin. All the patients reported a clinical improvement. Conclusions: The present study suggests that Rifaximin may be able to improve intestinal dysbiosis and gastrointestinal symptoms due to SIBO, with results that seem to be more evident when rifaximin is administered in two monthly cycles rather than one.

Keywords

• gut microbiota
• small intestinal bacterial overgrowth
• rifaximin.