From the Guidelines
Rifaximin is unlikely to cause Clostridioides difficile (C. diff) infection. Unlike many other antibiotics, rifaximin has a very low risk of causing C. diff because it works primarily in the intestines with minimal systemic absorption, and it preserves much of the normal gut microbiome while targeting pathogenic bacteria. Rifaximin is actually sometimes used as part of treatment regimens for recurrent C. diff infections because it can help restore normal gut flora, as suggested by the 2021 clinical practice guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) 1. The medication is typically prescribed at doses of 400 mg three times daily for 20 days following vancomycin for recurrent C. diff infections. While any antibiotic theoretically carries some risk of disrupting gut bacteria and potentially allowing C. diff to flourish, rifaximin has one of the lowest associations with C. diff infection among antibiotics. If you develop symptoms like watery diarrhea, abdominal pain, or fever while taking rifaximin, you should still contact your healthcare provider, as these could indicate C. diff or another infection requiring medical attention.
Key Points
- Rifaximin has a low risk of causing C. diff infection due to its minimal systemic absorption and preservation of normal gut microbiome.
- Rifaximin is used in treatment regimens for recurrent C. diff infections to help restore normal gut flora.
- The typical dose of rifaximin for recurrent C. diff infections is 400 mg three times daily for 20 days following vancomycin.
- Patients should still monitor for symptoms of C. diff or other infections while taking rifaximin and contact their healthcare provider if they occur.
Evidence Summary
The 2021 clinical practice guideline by the IDSA and SHEA 1 suggests that rifaximin can be used as part of treatment regimens for recurrent C. diff infections. The guideline recommends vancomycin followed by rifaximin as an option for patients with multiple recurrences. This recommendation is based on the low risk of rifaximin causing C. diff infection and its ability to help restore normal gut flora. Additionally, the guideline suggests that rifaximin has one of the lowest associations with C. diff infection among antibiotics 1.
From the Research
Rifaximin and Clostridioides difficile Infection
- Rifaximin is a rifamycin derivative that has been used to treat certain bacterial infections.
- According to the studies, there is no direct evidence that Rifaximin causes Clostridioides difficile (C. diff) infection.
- However, the studies do mention Rifaximin as a potential treatment option for C. diff infection, particularly for recurrent cases 2, 3.
- The use of Rifaximin in treating C. diff infection is mentioned in the context of its potential to reduce recurrence rates, but its effectiveness and safety as a treatment option are not fully established 3.
- Other treatment options for C. diff infection, such as vancomycin, fidaxomicin, and fecal microbiota transplantation, are also discussed in the studies 4, 2, 3, 5, 6.
Treatment Options for C. diff Infection
- The studies discuss various treatment options for C. diff infection, including:
- Vancomycin and fidaxomicin as first-line treatments 4, 2, 3, 6
- Fecal microbiota transplantation as a treatment option for recurrent C. diff infection 2, 3, 5, 6
- Bezlotoxumab as a preventive measure against recurrence 2, 3, 5
- Other emerging treatments, such as microbiome-based therapies and antibiotic neutralization strategies 5