From the Guidelines
Rifaximin is primarily indicated for treating traveler's diarrhea caused by non-invasive E. coli, hepatic encephalopathy prevention, and irritable bowel syndrome with diarrhea (IBS-D), with the most effective dosage for hepatic encephalopathy prevention being 550 mg twice daily continuously to reduce the risk of recurrence, as supported by a recent study 1. The indications for Rifaximin include:
- Traveler's diarrhea caused by non-invasive E. coli
- Hepatic encephalopathy prevention
- Irritable bowel syndrome with diarrhea (IBS-D) The dosing guidelines for Rifaximin are as follows:
- For traveler's diarrhea, the standard dosage is 200 mg three times daily or 400 mg twice daily for 3 days in adults and children over 12 years
- For hepatic encephalopathy prevention, patients should take 550 mg twice daily continuously to reduce the risk of recurrence, as shown in a study where rifaximin reduced the risk of recurrent HE by 58% compared to placebo 1
- For IBS-D, the recommended dosage is 550 mg three times daily for 14 days, with potential retreatment for recurrent symptoms, as suggested by the AGA clinical practice guideline 1 Rifaximin works as a non-absorbable antibiotic that stays within the gastrointestinal tract, targeting intestinal bacteria while minimizing systemic absorption and side effects. It's particularly effective for hepatic encephalopathy because it reduces ammonia-producing bacteria in the gut. Common side effects include nausea, bloating, and headache, though these are typically mild. Rifaximin should be used cautiously in patients with severe hepatic impairment and is contraindicated in those with hypersensitivity to rifamycin antibiotics. No dosage adjustment is needed for renal impairment since the drug is minimally absorbed. Some key points to consider when using Rifaximin include:
- The use of Rifaximin in combination with lactulose for the prevention of recurrent overt hepatic encephalopathy, as recommended by the French guidelines 1
- The potential for Rifaximin to reduce the risk of post-TIPS HE, as shown in a French RCT 1
- The effectiveness of Rifaximin in preventing traveler's diarrhea, as demonstrated in several studies 1
From the FDA Drug Label
XIFAXAN is a rifamycin antibacterial indicated for: • Treatment of travelers’ diarrhea (TD) caused by noninvasive strains of Escherichia coli in adult and pediatric patients 12 years of age and older (1.1) • Reduction in risk of overt hepatic encephalopathy (HE) recurrence in adults (1.2) • Treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults (1. 3)
Condition Recommended Dosage Regimen TD (2.1) One 200 mg tablet 3 times a day for 3 days HE (2.2) One 550 mg tablet 2 times a day IBS-D (2. 3) One 550 mg tablet 3 times a day for 14 days.
The indications for Rifaxmin (Rifaximin) are:
- Travelers’ diarrhea caused by noninvasive strains of Escherichia coli in adult and pediatric patients 12 years of age and older
- Reduction in risk of overt hepatic encephalopathy (HE) recurrence in adults
- Treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults The dosing guidelines are:
- TD: 200 mg tablet 3 times a day for 3 days
- HE: 550 mg tablet 2 times a day
- IBS-D: 550 mg tablet 3 times a day for 14 days 2
From the Research
Indications for Rifaxmin
- Rifaximin is approved by the US FDA for the treatment of travelers' diarrhea caused by noninvasive strains of Escherichia coli in patients aged 12 years and older 3
- Rifaximin is also approved for the reduction in risk of overt hepatic encephalopathy (HE) recurrence in patients aged 18 years or older 3
- Rifaximin is effective in the acute treatment of overt encephalopathy and in preventing recurrence 4, 5
Dosing Guidelines for Rifaxmin
- For the treatment of travelers' diarrhea, rifaximin is typically administered at a dose of 200 mg three times a day for 3 days 6, 7
- For the reduction in risk of overt hepatic encephalopathy (HE) recurrence, rifaximin is typically administered at a dose of 550 mg twice daily 5
- Rifaximin can be used in combination with other treatments, such as lactulose, for the management of hepatic encephalopathy 5
Efficacy of Rifaxmin
- Rifaximin has been shown to be effective in reducing the risk of hepatic encephalopathy recurrence 5
- Rifaximin has been shown to be effective in the treatment of travelers' diarrhea caused by noninvasive pathogens 6, 7
- Rifaximin is a viable alternative to ciprofloxacin for the treatment of travelers' diarrhea, with the advantage of leading to the development of less resistance and fewer systemic adverse effects 6