Interaction between rifaximin and dietary.pdf

Interaction between rifaximin and dietary fibre in patients with diverticular disease R. D’ INCA?* , F . POMERRI , M. G. VETTORATO* , E . DAL PONT* , V . DI LEO* , A. FERRONATO* , V . MEDICI* G. C. STURNIOLO* Departments of *Surgical and Gastro- enterological Sciences and Radiol- ogy, University of Padua, Padua, Italy Correspondence to: Dr R. D’Inca?, Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Policlinico, Via Giustiniani 2, I-35100 Padova, Italy. E-mail: dinca@unipd.it Publication data Submitted 3 July 2006 First decision 17 July 2006 Resubmitted 6 October 2006 Resubmitted 24 January 2007 Accepted 25 January 2007 SUMMARY Background Cyclic administration of rifaximin in association with dietary fibre achieves symptomatic relief in uncomplicated diverticular disease (DD) by means of a still undefined mechanism. Aim To investigate the effects of a combination of rifaximin and fibre on both hydrogen production by intestinal microflora and oro-anal transit time. Methods In a controlled, double-blind crossover trial, 64 patients with uncompli- cated DD were given bran (20 g/day) and randomly treated with rifaxi- min (1200 mg/day) or a placebo for 14 days. Evaluation was based on clinical status, breath test, oro-anal transit time and faecal weight. Results The global symptomatic score was significantly reduced after rifaximin (7.1  4.1 to 4.1  3.3; P 0.005) but not after placebo (6.8  3.8 to 6.1  3.5). Hydrogen production significantly increased after placebo from 198  134 to 267  161 ppm/min, while Rifaximin reduced it from 222  187 to 166  131 ppm/min (P ? 0.05). The total oro-anal transit time decreased from 56.1  28.2 to 51.3  28.0 h in placebo and from 54.4  31.9 to 45.1  32.4 h (P 0.05) in rifaximin-treated patients. Conclusions The administration of rifamixin improves the benefits of dietary fibre in uncomplicated DD by preventing its bacterial degradation. Aliment Pharmacol Ther 25, 771–779 Alimentary Pharmacology Therapeutics a