Review article: The role of antibiotics vs. conventional pharmacotherapy in treating symptoms of irritable bowel syndrome

[Note: Rifaximin is an antibiotic that will not pass the gastrointestinal wall into the blood stream, as do most other orally administered antibiotics. It is licensed for use to treat E. coli diarrhea, but may be prescribed off label for chronic bloating/flatulence in IBS.]

Journal: Alimentary Pharmacology & Therapeutics. 2007 June 1;25(11):1271-81

Authors and affiliation: Frissora CL, Cash BD. Division of Gastroenterology and Hepatology, Weill Cornell Medical College of Cornell University, New York, NY, USA. [E-mail: cfrissor@med.cornell.edu ]

PMID: 17509095

Background: The concept of augmenting the management of irritable bowel syndrome with antibiotics is evolving, and many questions remain regarding this therapy relative to known and hypothesized irritable bowel syndrome pathophysiology.

The clinical evidence of small intestinal bacterial overgrowth as an important aetiology of irritable bowel syndrome continues to accumulate. Clinical symptoms of bacterial overgrowth and irritable bowel syndrome are similar; however, a definitive cause-and-effect relationship remains unproven.

It is unclear whether motility dysfunction causes bacterial overgrowth or gas products of enteric bacteria affect intestinal motility in irritable bowel syndrome.

Aim: To discuss the efficacy and tolerability of current symptom-directed pharmacotherapies and of antibiotics in the treatment of irritable bowel syndrome.

Methods: A computerized search of PubMed was performed with search terms 'IBS', 'pharmacotherapy' and 'antibiotics'. Relevant articles were selected, and the reference list of selected articles was reviewed to identify additional references.

Results: Antibiotic treatment benefits a subset of irritable bowel syndrome patients. The non-absorbed antibiotic rifaximin has a favorable safety and tolerability profile compared with systemic antibiotics and demonstrates a therapeutic efficacy comparable with symptom-based irritable bowel syndrome pharmacotherapies.

Conclusion: Rifaximin is the only antibiotic with demonstrated sustained benefit beyond therapy cessation in irritable bowel syndrome patients in a placebo-controlled trial. Whether antibiotics can improve quality of life in patients with irritable bowel syndrome warrants further research.

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