Rifaximin: a unique gastrointestinal-selective antibiotic for enteric diseases
Open accessAbstract
PURPOSE OF REVIEW: Rifaximin is gaining attention for its potential activity in a multitude of gastrointestinal diseases. We review the unique pharmaceutical properties of this antibiotic and the published evidence in the literature regarding the use of rifaximin for different gastrointestinal disorders. RECENT FINDINGS: Rifaximin is a gastrointestinal-selective antibiotic with a broad spectrum of antimicrobial activity, an excellent safety profile, minimal drug interactions, and negligible impact on the intestinal microbiome. Rifaximin is currently approved in the United States for the treatment of travelers' diarrhea caused by noninvasive diarrheagenic Escherichia coli and is approved in more than 30 other countries for a variety of gastrointestinal disorders. Considerable research with this medication has been conducted for the treatment and prevention of travelers' diarrhea, the treatment of portal systemic encephalopathy, Clostridium difficile infection, small bowel intestinal overgrowth, irritable bowel syndrome, inflammatory bowel disease, pouchitis, and colonic diverticular disease. SUMMARY: Rifaximin is effective for the treatment of travelers' diarrhea and can be considered as the treatment of choice for uncomplicated travelers' diarrhea. When invasive travelers' diarrhea pathogens are suspected, an alternative antibiotic should be administered. Rifaximin appears promising as a chemoprophylaxis for travelers' diarrhea and as a treatment of portal systemic encephalopathy. This antibiotic may be effective for other gastrointestinal diseases, but more well designed clinical studies are needed to confirm its efficacy for these off-label indications. Future studies will determine whether the development of significant bacterial resistance will limit rifaximin use.
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Rifaximin is a nonabsorbable antibiotic with broad-spectrum antimicrobial activity and an excellent safety profile.
“Rifaximin is a nonabsorbable antibiotic with broad-spectrum antimicrobial activity and an excellent safety profile113 that was initially approved for the treatment of traveller’s diarrhoea but is increasingly used for the prevention of hepatic encephalopathy99.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [113]
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“Rifaximin [Rifax; Xifaxan; 4-deoxy-4 -methylpyrido[1 ,2 1,2]imidazo[5,4-c]rifamycin SV], a nonsystemic rifamycin-derived antibiotic that exhibits low gastrointestinal absorption while retaining potent antibacterial activity (Koo and DuPont, 2010), was approved in 2004 for the treatment of traveler’s diarrhea (Laustsen…”
BackgroundGangarapu, V., İnce, A. T., Baysal, B., Kayar, Y., Klç, U., Gök, Ö., Uysal, Ö., & Şentürk, H. (2015) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000000348 · Cited by 153 · see citing works
Gut microbiota in alcoholic liver disease: Pathogenetic role and therapeutic perspectives
Malaguarnera, G. (2014) · World Journal of Gastroenterology · doi:10.3748/wjg.v20.i44.16639 · Cited by 147 · see citing works
Diarrheagenic Escherichia coli in sub-Saharan Africa: Status, Uncertainties and Necessities
Okeke, I. N. (2009) · The Journal of Infection in Developing Countries · doi:10.3855/jidc.586 · Cited by 142 · see citing works
Clostridium difficile Infection
Heinlen, L. D., & Ballard, J. D. (2010) · The American Journal of the Medical Sciences · doi:10.1097/maj.0b013e3181e939d8 · Cited by 140 · see citing works
New treatments and therapeutic targets for IBS and other functional bowel disorders
Simrén, M., & Tack, J. (2018) · Nature reviews: Gastroenterology & hepatology · doi:10.1038/s41575-018-0034-5 · Cited by 127 · see citing works
Clostridium difficile Infection: New Insights Into Management
Khanna, S., & Pardi, D. S. (2012) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2012.07.016 · Cited by 134 · see citing works
Masters, K., Rauws, T. R. M., Yadav, A. K., Herrebout, W., van der Veken, B., & Maes, B. U. W. (2011) · Chemistry - A European Journal · doi:10.1002/chem.201100574 · Cited by 133 · see citing works
Kalambokis, G. N., Mouzaki, A., Rodi, M., Pappas, K., Fotopoulos, A., Xourgia, X., & Tsianos, E. V. (2012) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2012.02.025 · Cited by 130 · see citing works
The Role of the Gut Microbiome in Liver Cirrhosis Treatment
Lee, N. Y., & Suk, K. T. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms22010199 · Cited by 125 · see citing works
“Rifaximin is a gastrointestinal selective antibiotic with a wide range of antimicrobial activity, minimal drug interactions and negligible effect on the overall gut microbiome [58] (Table 1).”
BackgroundRifaximin: beyond the traditional antibiotic activity
Calanni, F., Renzulli, C., Barbanti, M., & Viscomi, G. C. (2014) · The Journal of Antibiotics · doi:10.1038/ja.2014.106 · Cited by 119 · see citing works
Probiotics for patients with hepatic encephalopathy
McGee, R., Bakens, A., Wiley, K. E., Riordan, S. M., & Webster, A. C. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008716.pub2 · Cited by 117 · see citing works
Weber, D., Oefner, P. J., Dettmer, K., Hiergeist, A., Koestler, J., Gessner, A., Weber, M., Stämmler, F., Hahn, J. R., Wolff, D., et al. (2016) · Bone Marrow Transplantation · doi:10.1038/bmt.2016.66 · Cited by 112 · see citing works
Small Intestinal Bacterial Overgrowth
Quigley, E. M. M., & Abu-Shanab, A. (2010) · Infectious Disease Clinics of North America · doi:10.1016/j.idc.2010.07.007 · Cited by 108 · see citing works
Elfert, A., Abo Ali, L., Soliman, S., Ibrahim, S., & Abd-Elsalam, S. (2016) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000000724 · Cited by 105 · see citing works
Hill, D. R., & Beeching, N. J. (2010) · Current Opinion in Infectious Diseases · doi:10.1097/qco.0b013e32833dfca5 · Cited by 104 · see citing works
Gut microbiome and liver disease
Betrapally, N. S., Gillevet, P. M., & Bajaj, J. S. (2016) · Translational research · doi:10.1016/j.trsl.2016.07.005 · Cited by 104 · see citing works
“Rifaximin is a broad spectrum bacteria that w s used to reduce the overall burden of intestinal microbiota by non-selectively eliminatin g gut microbes (114) (115).”
BackgroundRifaximin in nonalcoholic fatty liver disease: hit multiple targets with a single shot
Abdel‐Razik, A., Mousa, N., Shabana, W., Refaey, M., Elzehery, R. R., Elhelaly, R. M., Zalata, K., Abdelsalam, M., Eldeeb, A. A., Awad, M., et al. (2018) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000001232 · Cited by 96 · see citing works
Robertsen, H. L., & Musiol-Kroll, E. M. (2019) · Antibiotics · doi:10.3390/antibiotics8040157 · Cited by 89 · see citing works
“Although the continuous administration of rifaximin has raised concerns for selection of resistance and undesirable disruption of the gut microbiota, several studies have shown that rifaximin may promote a healthy gut microbiota [117,260,261].”
BackgroundRifaximin vs conventional oral therapy for hepatic encephalopathy: A meta-analysis
Eltawil, K. M. (2012) · World Journal of Gastroenterology · doi:10.3748/wjg.v18.i8.767 · Cited by 81 · see citing works
Shinde, M. H., & Kshirsagar, U. A. (2015) · Green Chemistry · doi:10.1039/c5gc02771c · Cited by 80 · see citing works
Xie, Y., Wu, J., Che, X., Chen, Y., Huang, H., & Deng, G. (2015) · Green Chemistry · doi:10.1039/c5gc01978h · Cited by 75 · see citing works
Access to Imidazo[1,2-a]pyridines via Annulation of α-Keto Vinyl Azides and 2-Aminopyridines
Adiyala, P. R., Mani, G. S., Nanubolu, J. B., Shekar, K. C., & Maurya, R. A. (2015) · Organic Letters · doi:10.1021/acs.orglett.5b02124 · Cited by 67 · see citing works
Epidemiology, diagnosis and treatment ofClostridium difficileinfection
Bassetti, M., Villa, G. C. F., Pecori, D., Arzese, A., & Wilcox, M. H. (2012) · Expert Review of Anti-infective Therapy · doi:10.1586/eri.12.135 · Cited by 65 · see citing works
Berg, D., Clemente, J. C., & Colombel, J. (2015) · Expert Review of Gastroenterology & Hepatology · doi:10.1586/17474124.2015.1013031 · Cited by 64 · see citing works
“For this reason, rifaximin, which is an antibacterial agent virtually free of systemic side effects due to its minimal absorption after oral intake, has become an attractive alternative in IBD patients [73].”
BackgroundRifaximin intake leads to emergence of rifampin-resistant staphylococci
Valentin, T., Leitner, E., Rohn, A., Zollner‐Schwetz, I., Hoenigl, M., Salzer, H. J. F., & Krause, R. (2010) · Journal of Infection · doi:10.1016/j.jinf.2010.11.004 · Cited by 62 · see citing works
Kalambokis, G. N., & Tsianos, E. V. (2011) · Hepatology · doi:10.1002/hep.24751 · Cited by 61 · see citing works
Update on chronic intestinal pseudo-obstruction
Zenzeri, L., Tambucci, R., Quitadamo, P., Giorgio, V., GIORGIO, R. D., & Nardo, G. D. (2020) · Current Opinion in Gastroenterology · doi:10.1097/mog.0000000000000630 · Cited by 58 · see citing works
Assem, M., Elsabaawy, M., Abdelrashed, M., El-Emam, S. M., Khodeer, S. A., Hamed, W., Abdelaziz, A., & El-Azab, G. (2015) · Hepatology International · doi:10.1007/s12072-015-9688-z · Cited by 58 · see citing works
Hong, C., Chan, L., Chen, K., Lee, H., Huang, L., Yang, Y. S. H., Liu, Y., & Hu, C. (2022) · Cells · doi:10.3390/cells11213468 · Cited by 55 · see citing works
“Given that rifaximin is a 99% nonabsorbable antibiotic [64], its anti-inflammatory and neuroprotective effects most likely resulted from the gut, especially through the modification of GM.”
BackgroundPistiki, A. C., Galani, I., Pyleris, E., Barbatzas, C., Pimentel, M., & Giamarellos‐Bourboulis, E. J. (2014) · International Journal of Antimicrobial Agents · doi:10.1016/j.ijantimicag.2013.12.008 · Cited by 55 · see citing works
“The hypothesis that SIBO is important in IBS led to the concept that oral intake of non-absorbable antibiotics may inhibit SIBO and offer alleviation of symptoms [4,5].”
BackgroundKalambokis, G. N., Mouzaki, Α., Rodi, M., & Tsianos, E. V. (2011) · Liver International · doi:10.1111/j.1478-3231.2011.02650.x · Cited by 52 · see citing works
“The only documented property of rifaximin is its broad spectrum antimicrobial activity against both aerobic and anaerobic gram-positive and gram-negative micro-organisms within the gastrointestinal tract, which accounts for its long-term use in the treatment of hepatic encephalopathy (12, 13).”
BackgroundDiscovery of disease-adapted bacterial lineages in inflammatory bowel diseases
Kumbhari, A., Cheng, T. N. H., Ananthakrishnan, A. N., Kochar, B., Burke, K. E., Shannon, K., Lau, H., Xavier, R. J., & Smillie, C. S. (2024) · Cell Host & Microbe · doi:10.1016/j.chom.2024.05.022 · Cited by 54 · see citing works
Rifaximin in the treatment of inflammatory bowel disease
Guslandi, M. (2011) · World Journal of Gastroenterology · doi:10.3748/wjg.v17.i42.4643 · Cited by 50 · see citing works
Darbandi, A., Mirshekar, M., Shariati, A., Moghadam, M. T., Lohrasbi, V., Asadollahi, P., & Talebi, M. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2019.11.008 · Cited by 50 · see citing works
Clostridium difficile infection: management strategies for a difficult disease
Khanna, S., & Pardi, D. S. (2013) · Therapeutic Advances in Gastroenterology · doi:10.1177/1756283x13508519 · Cited by 47 · see citing works
“Rifaximin is a broad spectrum antimicrobial agent selective to the gastrointestinal tract, which has activity against most Gramnegative and Gram-positive bacteria, as well as anaerobes and aerobes and excellent in vitro activity against C. difficile [Koo and Dupont, 2010].”
BackgroundWang, J., Zhang, L., & Hou, X. (2021) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2021.2005579 · Cited by 47 · see citing works
“Low absorption of rifaximin in the gastrointestinal tract enhances fecal concentrations and limits its systemic toxicity [14].”
BackgroundSanapalli, B. K. R., Ashames, A., Sigalapalli, D. K., SHAIK, A. B., Bhandare, R. R., & Yele, V. (2022) · Antibiotics · doi:10.3390/antibiotics11121680 · Cited by 48 · see citing works
Clinical Implications of Enteroadherent Escherichia coli
Arenas-Hernández, M. M. P., Martínez‐Laguna, Y., & Torres, A. G. (2012) · Current Gastroenterology Reports · doi:10.1007/s11894-012-0277-1 · Cited by 44 · see citing works
The war against bacteria, from the past to present and beyond
Bottalico, L., Charitos, I. A., Potenza, M. A., Montagnani, M., & Santacroce, L. (2021) · Expert Review of Anti-infective Therapy · doi:10.1080/14787210.2022.2013809 · Cited by 45 · see citing works
Imidazopyridine-based kinase inhibitors as potential anticancer agents: A review
Peytam, F., Emamgholipour, Z., Mousavi, A., Moradi, M., Foroumadi, R., Firoozpour, L., Divsalar, F., Safavi, M., & Foroumadi, A. (2023) · Bioorganic Chemistry · doi:10.1016/j.bioorg.2023.106831 · Cited by 45 · see citing works
Rifaximin for the treatment of hepatic encephalopathy
Mullen, K. D., & Prakash, R. (2010) · Expert Review of Gastroenterology & Hepatology · doi:10.1586/egh.10.78 · Cited by 42 · see citing works
Part 2: Treatments for Chronic Gastrointestinal Disease and Gut Dysbiosis.
Bull, M. J., & Plummer, N. T. (2015) · PubMed Central · Cited by 41 · see citing works
Modifications, biological origin and antibacterial activity of naphthalenoid ansamycins
Skrzypczak, N., & Przybylski, P. (2022) · Natural Product Reports · doi:10.1039/d2np00002d · Cited by 40 · see citing works
Alajbegovic, S., Sanders, J. W., Atherly, D., & Riddle, M. S. (2012) · Systematic Reviews · doi:10.1186/2046-4053-1-39 · Cited by 40 · see citing works
“A number of traditional and systematic qualitative reviews on the use of chemoprophylaxis, and in particular rifaximin, have been reported in the past few years and have generally favored the consideration of rifaximin for prevention of TD among high-risk groups or the risk-averse traveler [17-21].”
BackgroundIleocecal valve dysfunction in small intestinal bacterial overgrowth: A pilot study
Miller, L. S. (2012) · World Journal of Gastroenterology · doi:10.3748/wjg.v18.i46.6801 · Cited by 40 · see citing works
Gut microbiota and sirtuins in obesity-related inflammation and bowel dysfunction
Lakhan, S. E., & Kirchgessner, A. L. (2011) · Journal of Translational Medicine · doi:10.1186/1479-5876-9-202 · Cited by 39 · see citing works
“Treatment with rifaximin (Xifaxan, Salix Pharmaceuticals, Morrisville, NC, USA), a nonsystemic rifamycinderived antibiotic that exhibits low gastrointestinal absorption while retaining potent antibacterial activity [51] for two weeks has recently been shown to provide significant relief of symptoms associated with IBS…”
BackgroundMiller, M. A., Blanchette, R., Spigaglia, P., Barbanti, F., & Mastrantonio, P. (2011) · Journal of Clinical Microbiology · doi:10.1128/jcm.05100-11 · Cited by 39 · see citing works
“In particular, RFX is licensed as a treatment for hepatic encephalopathy, diarrhea, and travelers’ diarrhea and as prophylaxis for gastrointestinal surgery (11, 23, 24).”
BackgroundDong, L., Huang, J., Qu, C., Zhang, Q., Zhang, W., Han, B., & Peng, C. Y. (2013) · Organic & Biomolecular Chemistry · doi:10.1039/c3ob41177j · Cited by 38 · see citing works
Lim, Y. L., Kim, M. Y., Jang, Y. O., Baik, S. K., & Kwon, S. O. (2017) · Gut and Liver · doi:10.5009/gnl16478 · Cited by 38 · see citing works
“Rifaximin is an antibiotic with broad antimicrobial, high fecal concentration, and low systemic absorption.(12,30) In cirrhotic patients, the effectiveness of rifaximin has been investigated in many clinical trials that have addressed hepatic encephalopathy remission and prevention.”
BackgroundPraharaj, D. L., Premkumar, M., Roy, A., Verma, N., Taneja, S., Duseja, A. K., & Dhiman, R. K. (2021) · Journal of Clinical and Experimental Hepatology · doi:10.1016/j.jceh.2021.08.010 · Cited by 36 · see citing works
Roszkowska, P., Klimczak, E., Ostrycharz, E., Rączka, A., Wojciechowska‐Koszko, I., Dybus, A., Cheng, Y.-H., Yu, Y., Mazgaj, S., & Hukowska-Szematowicz, B. (2024) · Biomedicines · doi:10.3390/biomedicines12051030 · Cited by 35 · see citing works
Tsutsumi, L. S., Owusu, Y., Hurdle, J. G., & Sun, D. (2013) · Current Topics in Medicinal Chemistry · doi:10.2174/1568026613666131113154753 · Cited by 35 · see citing works
“015 g/mL [94] and is primarily used for the treatment of traveler’s diarrhea caused by noninvasive strains of Escherichia coli [72, 95, 96].”
Zanger, P., Nurjadi, D., Gabor, J. J., Gaile, M., & Kremsner, P. G. (2013) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(13)70221-4 · Cited by 35 · see citing works
Targeted therapy of irritable bowel syndrome with anti-inflammatory cytokines
Kumar, S., Singh, P., & Kumar, A. (2021) · Clinical Journal of Gastroenterology · doi:10.1007/s12328-021-01555-8 · Cited by 35 · see citing works
Rifaximin - Chitosan Nanoparticles for Inflammatory Bowel Disease (IBD)
Kumar, J., & Amaldoss, M. J. N. (2017) · Recent Patents on Inflammation & Allergy Drug Discovery · doi:10.2174/1872213x10666161230111226 · Cited by 34 · see citing works
Mostafa, T. M., Badra, G., & Abdallah, M. (2015) · The Turkish Journal of Gastroenterology · doi:10.5152/tjg.2015.7782 · Cited by 34 · see citing works
“In the present prospective study, rifaximin was superior to norfloxacin because it is virtually non-absorbable, subsequently minimizing antimicrobial resistance, and maintains the drug safety in all patient populations (9,11).”
BackgroundSoni, H., Kumar, P. M., Sharma, V., Bellam, B. L., Mishra, S., Mahendru, D., Mandavdhare, H. S., Medhi, B., Dutta, U., & Singh, V. (2020) · Hepatology International · doi:10.1007/s12072-020-10025-1 · Cited by 32 · see citing works
Recurrent Clostridium difficile Infection
Pannerden, C. V. N. T., Verbon, A., & Kuipers, E. J. (2011) · Drugs · doi:10.2165/11591230-000000000-00000 · Cited by 32 · see citing works
“difficile shows good in vitro susceptibility to rifaximin,([69]) although rifaximinresistant C.”
Is Rifaximin Effective in Maintaining Remission in Crohn's Disease?
Jigaranu, A. O., Nedelciuc, O., Blaj, A., Badea, M., Mihai, C., Diculescu, M., & Prelipcean, C. C. (2014) · Digestive Diseases · doi:10.1159/000358141 · Cited by 32 · see citing works
Gupta, N., Chauhan, K., Singh, G., Chaudhary, S., & Rathore, J. S. (2025) · The Microbe · doi:10.1016/j.microb.2025.100233 · Cited by 29 · see citing works
Kutmutia, R., Tittanegro, T., China, L., Forrest, E. H., Kallis, Y. N., Ryder, S. D., Wright, G. A. K., Freemantle, N., & O'Brien, A. J. (2022) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001937 · Cited by 28 · see citing works
Rifaximin for the treatment of acute infectious diarrhea
Hong, K. S., & Kim, J. S. (2011) · Therapeutic Advances in Gastroenterology · doi:10.1177/1756283x11398734 · Cited by 27 · see citing works
“Acute diarrhea unrelated to travel Although rifaximin was approved only for the treatment of travelers’ diarrhea in the United States, it is indicated for infectious diarrhea independent of the travel history in most other countries where rifaximin is marketed, including South Korea [Koo and Dupont, 2010].”
BackgroundInfluentialCyclic antibiotic therapy for diverticular disease: a critical reappraisal.
Zullo, A., Hassan, C., Maconi, G., Manes, G., Tammaro, G., Francesco, V. D., Annibale, B., Ficano, L., Buri, L., Gatto, G., et al. (2010) · PubMed · Cited by 27 · see citing works
Probing gut‐brain links in Alzheimer's disease with rifaximin
Suhocki, P. V., Ronald, J., Diehl, A. M., Murdoch, D. M., & Doraiswamy, P. M. (2022) · Alzheimer s & Dementia Translational Research & Clinical Interventions · doi:10.1002/trc2.12225 · Cited by 27 · see citing works
TMIO-PyrImid Hybrids are Profluorescent, Site-Directed Spin Labels for Nucleic Acids
Chalmers, B. A., Saha, S., Nguyen, T., McMurtrie, J. C., Sigurdsson, S. T., Bottle, S. E., & Masters, K. (2014) · Organic Letters · doi:10.1021/ol502003a · Cited by 27 · see citing works
Elsheikh, M., Sabagh, A. E., Mohamed, I. B., Bhongade, M., Hassan, M. M., & Jalal, P. K. (2023) · World Journal of Gastroenterology · doi:10.3748/wjg.v29.i46.6028 · Cited by 26 · see citing works
“Its primary function is to specifically target and eradicate harmful bacteria in the intestinal tract[184].”
Solvent and catalyst‐free synthesis of imidazo[1,2‐a]pyridines by grindstone chemistry
Godugu, K., & Reddy, N. C. G. (2020) · Journal of Heterocyclic Chemistry · doi:10.1002/jhet.4164 · Cited by 26 · see citing works
Gut Microbiota, Peroxisome Proliferator-Activated Receptors, and Hepatocellular Carcinoma
Yu, Q., Wu, L., Ji, J., Feng, J., Dai, W., Li, J., Wu, J., & Guo, C. (2020) · Journal of Hepatocellular Carcinoma · doi:10.2147/jhc.s277870 · Cited by 27 · see citing works
Han, S. S., Shannahan, S. E., & Pellish, R. S. (2015) · Journal of Intensive Care Medicine · doi:10.1177/0885066615594344 · Cited by 26 · see citing works
“This antibiotic is not absorbed by the GI tract nor inactivated by gastric secretions while exerting its effects only within the intestinal lumen.(83,84) There have been small clinical trials testing its effects against C difficile, which have shown it to be fairly effective.”
BackgroundNovel prevention strategies for bacterial infections in cirrhosis
Yan, K. G., & García–Tsao, G. (2016) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2016.1145663 · Cited by 26 · see citing works
“[31,32] However, a recent study shows that, rather than changing the stool microbiome, it seems to have a direct effect on bacterial function by impairing their ability to translocate.”
BackgroundPayra, S., Saha, A., Wu, C., Selvaratnam, B., Dramstad, T., Mahoney, L., Verma, S. K., Thareja, S., Koodali, R. T., & Banerjee, S. (2016) · New Journal of Chemistry · doi:10.1039/c6nj02134d · Cited by 26 · see citing works
Emerging role of probiotics and antimicrobials in the management of irritable bowel syndrome
Cash, B. D. (2014) · Current Medical Research and Opinion · doi:10.1185/03007995.2014.908278 · Cited by 25 · see citing works
Chen, Z., Liang, P., Xu, F., Qiu, R., Tan, Q., Long, L., & Ye, M. (2019) · The Journal of Organic Chemistry · doi:10.1021/acs.joc.9b01188 · Cited by 25 · see citing works
Bile acid–gut microbiota crosstalk in irritable bowel syndrome
Gu, Y., Li, L., Yang, M., Liu, T., Song, X., Qin, X., Xu, X. J., Liu, J., Wang, B., & Cao, H. (2022) · Critical Reviews in Microbiology · doi:10.1080/1040841x.2022.2058353 · Cited by 26 · see citing works
Gut microbiome and its metabolites in liver cirrhosis: mechanisms and clinical implications
Chang, L., Liu, Y., Li, H., Yan, J., Wu, W., Chen, N., Ma, C., Zhao, X., Chen, J., & Zhang, J. (2025) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2025.1717696 · Cited by 25 · see citing works
“It broadly suppresses enteric pathogens while sparing many commensal organisms (Koo and DuPont, 2010).”
Rifaximin for the prevention of spontaneous bacterial peritonitis
Kalambokis, G. N. (2012) · World Journal of Gastroenterology · doi:10.3748/wjg.v18.i14.1700 · Cited by 23 · see citing works
Chronic Intestinal Pseudo-Obstruction: Is There a Connection with Gut Microbiota?
Radocchia, G., Neroni, B., Marazzato, M., Capuzzo, E., Zuccari, S., Pantanella, F., Zenzeri, L., Evangelisti, M., Vassallo, F., Parisi, P., et al. (2021) · Microorganisms · doi:10.3390/microorganisms9122549 · Cited by 22 · see citing works
“Nevertheless, the most recent recommended agent is rifaximin, a poorly absorbed antibiotic that, differently to the others, exerts nontraditional effects on the gut microbiota in addition to bactericidal/bacteriostatic activity, producing lower bacterial resistance than traditional agents [41,42].”
BackgroundA Chemoselective N-Arylation Reaction of 2-Aminopyridine Derivatives with Arynes
Cheng, B., Wei, J., Zu, B., Zhao, J., Wang, T., Duan, X., Wang, R., Li, Y., & Zhai, H. (2017) · The Journal of Organic Chemistry · doi:10.1021/acs.joc.7b01405 · Cited by 20 · see citing works
Diagnosis of symptomatic uncomplicated diverticular disease and the role of Rifaximin in management.
Maconi, G. (2017) · Acta bio-medica dell'Ateneo parmense/Acta biomedica · doi:10.23750/abm.v88i1.6360 · Cited by 20 · see citing works
“One reason for the low frequency of adverse events is that the alpha polymorphic form of rifaximin has negligible gut absorption and systemic availability (52).”
BackgroundBoulos, M., Mousa, R. S., Jeries, N., Simaan, E., Alam, K., Bulus, B., & Assy, N. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26073448 · Cited by 21 · see citing works
“We advise the investigation of this drug since it is gut selective with almost no systemic bioavailability (less than 0.04% in blood stream) and could avoid possible antibiotics resistance in the long-term effects [278,282,283].”
InfluentialWeight Loss in Parkinson’s Disease: No Evidence for Role of Small Intestinal Bacterial Overgrowth
DiBaise, J. K., Crowell, M. D., Driver‐Dunckley, E. D., Mehta, S. H., Hoffman‐Snyder, C., Lin, T. P., & Adler, C. H. (2018) · Journal of Parkinson s Disease · doi:10.3233/jpd-181386 · Cited by 19 · see citing works
“Rifaximin (Xifaxin ® , Salix Pharmaceuticals Inc.), is an orally administered, semi-synthetic, non-systemic antibiotic [17] and is commonly used in the treatment of SIBO, although it is not United States Food and Drug Administration-approved for this indication.”
Reddy, K. R., Gupta, A. P., & Das, P. (2016) · Asian Journal of Organic Chemistry · doi:10.1002/ajoc.201600120 · Cited by 18 · see citing works
Gupta, A., Sasan, S., Kour, A., Nelofar, N., Mondhe, D. M., & Kapoor, K. K. (2019) · Synthetic Communications · doi:10.1080/00397911.2019.1605445 · Cited by 18 · see citing works
Rifaximin in the Treatment of Irritable Bowel Syndrome
Farrell, D. J. (2013) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0b013e31827559a3 · Cited by 17 · see citing works
Garrido‐Mesa, J., Algieri, F., Rodríguez‐Nogales, A., Vezza, T., Utrilla, M. P., García, F., Chueca, N., Rodríguez‐Cabezas, M. E., Garrido‐Mesa, N., & Gálvez, J. (2018) · Biochemical Pharmacology · doi:10.1016/j.bcp.2018.07.044 · Cited by 17 · see citing works
Discovery and Development of Antibacterial Agents: Fortuitous and Designed
Kapoor, B., Gulati, M., Kaur, R., Rani, P., Atanasov, A. G., Alzahrani, Q. E., Gupta, R., & Chawla, P. (2021) · Mini-Reviews in Medicinal Chemistry · doi:10.2174/1570193x19666211221150119 · Cited by 16 · see citing works
Buldain, D., Castillo, L. G., Buchamer, A., Aliverti, F., Bandoni, A. L., Marchetti, L., & Mestorino, N. (2020) · Frontiers in Veterinary Science · doi:10.3389/fvets.2020.00344 · Cited by 15 · see citing works
“RIF has been traditionally applied in human medicine to treat travelers’ diarrhea (15, 16) and hepatic encephalopathy (17).”
BackgroundKhezerloo, E., Hekmat, F., Shahrokhian, S., & zad, A. I. (2023) · Diamond and Related Materials · doi:10.1016/j.diamond.2023.110280 · Cited by 14 · see citing works
- Authors
- Koo, H. L., & DuPont, H. L.
- Affiliations
- Baylor College of Medicine (US)
- Baylor St. Luke's Medical Center (US)
- Corresponding author
- Koo, Hoonmo L
- ORCID
- DuPont, Herbert L
- Venue
- Current Opinion in Gastroenterology
- Published
- 2010-01
- Volume
- 26
- Issue
- 1
- Pages
- 17-25
- ISSN
- 0267-1379 (ISSN-L)
- PMC
- PMC4737517
- OpenAlex
- W2121076704
- Cited by
- 189
- References
- 76
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 13 · 2023: 8 · 2022: 15 · 2021: 13 · 2020: 11 · 2019: 9 · 2018: 10 · 2017: 7 · 2016: 10 · 2015: 12 · 2014: 11 · 2013: 10 · 2012: 18
- FWCI
- 2.12
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Current Opinion in Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- University of Houston
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK084513)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Infectious Diseases › Clostridium difficile and Clostridium perfringens research
- Keywords
- rifaximin, traveler's diarrhea, portal-systemic encephalopathy, Clostridium difficile infection, small intestinal bacterial overgrowth, irritable bowel syndrome, inflammatory bowel disease, pouchitis, colonic diverticular disease, chemoprophylaxis, gut microbiota, drug resistance
- MeSH terms
- Rifaximin, Anti-Infective Agents, Bacterial Infections, Dose-Response Relationship, Drug, Drug Administration Schedule, Dysentery, Female, Follow-Up Studies, Gastroenteritis, Humans, Male, Rifamycins, Travel, Randomized Controlled Trials as Topic, Treatment Outcome, Risk Assessment
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