What is the recommended interval between taking Rifaximin (Rifamycin) 550 and probiotics and prebiotics?

From the Guidelines

It is recommended to take probiotics and prebiotics at least 2-3 hours apart from Rifaximin (Xifaxan) 550 mg to minimize potential interactions and ensure the effectiveness of both treatments. This recommendation is based on the understanding that Rifaximin is a nonabsorbable antibiotic with a broad spectrum of activity against both gram-negative and gram-positive anaerobic and aerobic bacteria, as noted in the AGA clinical practice guideline on the pharmacological management of irritable bowel syndrome with diarrhea 1. The guideline suggests retreatment with rifaximin for patients with IBS-D who develop recurrent symptoms, indicating the drug's efficacy in managing symptoms related to bacterial overgrowth.

When considering the administration of probiotics and prebiotics with Rifaximin, the primary concern is the potential for the antibiotic to kill the beneficial bacteria in the probiotic supplement. However, Rifaximin's minimal absorption and targeted action against certain bacteria make it less likely to destroy probiotic strains compared to other antibiotics. Some studies and clinical practices suggest that taking certain probiotics concurrently with Rifaximin may even enhance therapeutic effects for conditions like Small Intestinal Bacterial Overgrowth (SIBO) or Irritable Bowel Syndrome (IBS) 1.

Key points to consider:

• Rifaximin works primarily in the gut to reduce bacterial overgrowth.
• Probiotics introduce beneficial bacteria into the gut.
• The timing of taking probiotics and prebiotics in relation to Rifaximin is crucial to avoid reducing the effectiveness of the probiotic.
• A 2-3 hour interval between taking Rifaximin and probiotics/prebiotics is generally recommended.
• Consultation with a healthcare provider is advised for personalized guidance, especially considering the specific condition being treated and the potential for concurrent use of Rifaximin and probiotics to enhance therapeutic effects.

From the Research

Interval Between Taking Rifaximin and Probiotics/Prebiotics

There is limited research directly addressing the recommended interval between taking Rifaximin 550 and probiotics or prebiotics. However, some studies provide insights into the concurrent or sequential use of these substances:

• A study from 2019 2 suggests that using a rifaximin-resistant probiotic strain (Bifidobacterium longum W11) concomitantly with rifaximin may confer clinical advantages in patients with symptomatic uncomplicated diverticular disease, including better clinical outcomes and improved stool consistency.
• Another study from 2013 3 evaluated the addition of probiotics or prebiotics to antibiotics (rifaximin) in treating small intestinal bacterial overgrowth (SIBO) and found that sequential administration of rifaximin followed by probiotics or prebiotics resulted in significant improvements in symptoms.
• The specific interval between taking rifaximin and probiotics/prebiotics is not explicitly stated in these studies, but they indicate that concurrent or sequential use can be beneficial in certain conditions.

Key Points to Consider

• The use of rifaximin-resistant probiotic strains may allow for concomitant administration with rifaximin 2.
• Sequential administration of rifaximin followed by probiotics or prebiotics may be effective in treating certain conditions, such as SIBO 3.
• More research is needed to determine the optimal interval between taking rifaximin and probiotics/prebiotics in various clinical contexts.

Relevant Studies

• 4: Update on the Management of Diarrhea-Predominant Irritable Bowel Syndrome: Focus on Rifaximin and Eluxadoline.
• 2: Effects of rifaximin-resistant Bifidobacterium longum W11 in subjects with symptomatic uncomplicated diverticular disease treated with rifaximin.
• 3: Effect of probiotic or prebiotic supplementation on antibiotic therapy in the small intestinal bacterial overgrowth: a comparative evaluation.
• 5: Rifaximin is safe and well tolerated for long-term maintenance of remission from overt hepatic encephalopathy.
• 6: Rifaximin alters gut microbiota profile, but does not affect systemic inflammation - a randomized controlled trial in common variable immunodeficiency.