Antibiotic May Aid Irritable Bowel
Xifaxan Reduces Bloating, May Attack Main IBS Cause
Oct. 16, 2006 -- Ten days' treatment with the antibiotic Xifaxan reduces
symptoms of irritable bowel syndrome (IBS), a small clinical trial
IBS is a condition of the intestinal tract that causes symptoms of bloating,
gas, abdominal cramping, diarrhea, and constipation.
Xifaxan, now approved for the treatment of travelers' diarrhea, kills
bacteria living in the gut. Experts disagree over the cause of IBS. Some
suspect the root cause to be overgrowth of gut bacteria.
One of these experts is Mark Pimentel, MD, director of the gastrointestinal
motility program at Cedars-Sinai Medical Center in Los Angeles. In prior
studies, Pimentel used breath tests to show that about 80% of IBS patients may
have serious bacterial fermentation going on in their gut.
This led him to wonder what would happen if he used a powerful antibiotic to
shift the balance between overgrowth of these theoretically harmful bacteria
and normal bacteria living in the gut.
So Pimentel and colleagues gave a 10-day course of Xifaxan or inactive
placebo to 87 IBS patients. Seventy-two patients finished the study. As is
common in IBS studies, those who got placebo felt a bit better. Those who got
Xifaxan reported even more improvement -- especially less bloating.
"Xifaxan was superior to placebo for control of IBS," Pimentel tells
WebMD. "It suggests we are finally tackling a sustainable cause of IBS. If
it is bacteria, we have changed the environment so that IBS is better on a
The study, funded by Xifaxan maker Salix Pharmaceuticals, appears in the
Oct. 17 issue of Annals of Internal Medicine. Pimentel is a consultant to Salix
and has received speaking fees from the company. Cedars-Sinai Medical Center
has a licensing agreement with Salix.
Change of IBS Treatment?
Is Xifaxan a new treatment for IBS? Not yet. A larger study, looking at IBS
patients treated by their own doctors with Xifaxan, is already underway. Until
those results are known, Xifaxan is not an officially approved treatment for
But Pimentel says he's treated "thousands" of IBS patients with
Xifaxan -- and he says now the word is getting out.
"The gem here is you have a sustained effect in IBS. The larger, longer
studies will show how well this works," he says. "We've reported these
results at professional meetings, and it has changed the way IBS is treated.
Sixty percent of gastroenterologists in the country are starting to do it this
Pimentel says the average patient needs re-treatment every two or three
months, but that response varies greatly from patient to patient.
Controversy Over IBS Treatment
Not all experts are convinced that bacterial overgrowth is a root cause of
IBS, or that antibiotics are the best treatment. One of these experts is
Douglas A. Drossman, MD, co-director of the University of North Carolina Center
for Functional GI and Motility Disorders, Chapel Hill.