Repeat Treatment With Rifaximin Is Safe and Effective in Patients With Diarrhea-Predominant Irritable Bowel Syndrome

Anthony Lembo, Mark Pimentel, Satish S. Rao, Philip Schoenfeld, Brooks Cash, Leonard B. Weinstock, Craig Paterson, Enoch Bortey, William P. Forbes

Research output: Contribution to journalArticlepeer-review

173 Scopus citations


Background & Aims Few treatments have demonstrated efficacy and safety for diarrhea-predominant irritable bowel syndrome (IBS-D). A phase 3, randomized, double-blind, placebo-controlled trial was performed to evaluate the safety and efficacy of repeat treatment with the nonsystemic antibiotic rifaximin. Methods The trial included adults with IBS-D, mean abdominal pain and bloating scores of 3 or more, and loose stool, located at 270 centers in the United States and Europe from February 2012 through June 2014. Those responding to a 2-week course of open-label rifaximin 550 mg 3 times daily, who then relapsed during an observation phase (up to 18 weeks), were randomly assigned to groups given repeat treatments of rifaximin 550 mg or placebo 3 times daily for 2 weeks. The primary end point was percentage of responders after first repeat treatment, defined as a decrease in abdominal pain of ≥30% from baseline and a decrease in frequency of loose stools of ≥50% from baseline, for 2 or more weeks during a 4-week post-treatment period. Results Of 1074 patients (44.1%) who responded to open-label rifaximin, 382 (35.6%) did not relapse and 692 (64.4%) did; of these, 636 were randomly assigned to receive repeat treatment with rifaximin (n = 328) or placebo (n = 308). The percentage of responders was significantly greater with rifaximin than placebo (38.1% vs 31.5%; P =.03). The percentage of responders for abdominal pain (50.6% vs 42.2%; P =.018) was significantly greater with rifaximin than placebo, but not stool consistency (51.8% vs 50.0%; P =.42). Significant improvements were also noted for prevention of recurrence, durable response, and bowel movement urgency. Adverse event rates were low and similar between groups. Conclusions In a phase 3 study of patients with relapsing symptoms of IBS-D, repeat rifaximin treatment was efficacious and well tolerated. ID: NCT01543178.

Original languageEnglish (US)
Pages (from-to)1113-1121
Number of pages9
Issue number6
StatePublished - Dec 1 2016


  • Bloating
  • Functional Bowel Disease
  • Nonabsorbed
  • Xifaxan

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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