Di Stefano M, Malservisi S, Veneto G, Ferrieri A, Corazza G R
Gastroenterology Unit, IRCCS 'S. Matteo' Hospital, University of Pavia, Pavia, Italy.
Aliment Pharmacol Ther. 2000 May;14(5):551-6. doi: 10.1046/j.1365-2036.2000.00751.x.
Bacterial overgrowth of the small intestine is a condition characterized by nutrient malabsorption due to an excessive number of bacteria in the lumen of the small intestine. Current treatment is based on empirical courses of broad spectrum antibiotics; few controlled data, with respect to the duration and choice of antibiotic drug, exist at present. The recent availability of rifaximin, a non-absorbable rifamycin derivative, highly effective against anaerobic bacteria, prompted us to carry out a randomized, double-blind controlled trial in order to compare its efficacy and tolerability to those of tetracycline, currently considered the first-choice drug.
In 21 patients affected by small intestinal bacterial overgrowth, fasting, peak and total H2 excretion after ingestion of 50 g glucose and severity of symptoms were evaluated before and after a 7-day course of rifaximin, 1200 mg/day (400 mg t.d.s.), or chlortetracycline, 1 g/day (333 mg t.d.s. ).
Fasting, peak and total H2 excretion decreased significantly in the group of patients treated with rifaximin whereas chlortetracycline did not modify these parameters. The H2 breath test normalized in 70% of patients after rifaximin and in 27% of patients after chlortetracycline. The improvement in symptoms was significantly higher in patients treated with rifaximin.
Rifaximin is a promising, easily-handled and safe drug for the short-term treatment of small intestinal bacterial overgrowth.
小肠细菌过度生长是一种由于小肠肠腔内细菌数量过多导致营养吸收不良的病症。目前的治疗基于经验性使用广谱抗生素疗程；目前关于抗生素药物的疗程和选择方面的对照数据很少。利福昔明是一种不可吸收的利福霉素衍生物，对厌氧菌高效，其近期面市促使我们开展一项随机、双盲对照试验，以比较其与目前被视为首选药物的四环素在疗效和耐受性方面的差异。
在21例患有小肠细菌过度生长的患者中，在接受为期7天的利福昔明（1200毫克/天，400毫克，每日三次）或金霉素（1克/天，333毫克，每日三次）治疗前后，评估空腹、摄入50克葡萄糖后的峰值和总氢气排泄量以及症状严重程度。
接受利福昔明治疗的患者组中，空腹、峰值和总氢气排泄量显著下降，而金霉素未改变这些参数。利福昔明治疗后70%的患者氢气呼气试验恢复正常，金霉素治疗后这一比例为27%。接受利福昔明治疗的患者症状改善明显更高。
利福昔明是一种有前景、易于使用且安全的药物，可用于小肠细菌过度生长的短期治疗。
