Division of Gastroenterology and Hepatology, Department of Internal Medicine, The University of Iowa Hospitals and Clinics, Internal Medicine, GI Division, 200 Hawkins Drive, Iowa City, IA 52242, USA.
Expert Rev Gastroenterol Hepatol. 2011 Aug;5(4):461-4. doi: 10.1586/egh.11.50.
Alterations in gut flora may play an important role in the pathophysiology of bowel symptoms, especially in patients with irritable bowel syndrome (IBS). If so, antibiotics that affect gut flora may offer a novel approach for the management of patients with IBS. Here, we discuss the results of two identically designed, double-blind, placebo-controlled trials (TARGET 1 and TARGET 2) of a poorly absorbed antibiotic, rifaximin, in patients with IBS. In these studies, 1260 patients (females 76.1 and 72.1%, respectively) who had IBS without constipation were randomized to receive either rifaximin 550 mg or placebo, three-times daily for 2 weeks. Subsequently, daily symptoms were assessed and patients were followed up for 10 weeks. The primary outcome measure - adequate relief of global IBS symptoms during the first 4 weeks after treatment - was met in significantly more patients who received rifaximin than placebo (p < 0.001). In addition, more patients in the rifaximin group than in the placebo group (p < 0.001) reported an adequate relief of bloating, and an improvement in abdominal pain and stool consistency - secondary outcome measures. The incidence of adverse events with rifaximin was similar to placebo, and the drug was well tolerated. In summary, a 2-week course of rifaximin provided significant relief of IBS symptoms, as well as bloating and abdominal pain.
肠道菌群的改变可能在肠症状的病理生理学中起重要作用，尤其是在肠易激综合征（IBS）患者中。如果是这样，影响肠道菌群的抗生素可能为 IBS 患者的治疗提供新方法。在这里，我们讨论了两种设计相同、双盲、安慰剂对照试验（TARGET 1 和 TARGET 2）的结果，这些试验研究了一种吸收不良的抗生素利福昔明在 IBS 患者中的应用。在这些研究中，1260 名（女性分别为 76.1%和 72.1%）无便秘的 IBS 患者被随机分为接受利福昔明 550mg 或安慰剂，每日 3 次，持续 2 周。随后，评估每日症状，并随访 10 周。主要疗效指标 - 治疗后第 4 周内 IBS 症状的充分缓解 - 在接受利福昔明治疗的患者中明显多于安慰剂组（p < 0.001）。此外，利福昔明组比安慰剂组（p < 0.001）有更多的患者报告腹胀得到充分缓解，腹痛和粪便稠度得到改善 - 次要疗效指标。利福昔明的不良反应发生率与安慰剂相似，且药物耐受性良好。总之，2 周疗程的利福昔明可显著缓解 IBS 症状以及腹胀和腹痛。
