Systematic review with meta-analysis: rifaximin is effective and safe for the treatment of small intestine bacterial overgrowth.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis including randomized controlled trials
PubMed 28078798 · doi:10.1111/apt.13928
What was done
Authors conducted a systematic review and meta-analysis searching MEDLINE, EMBASE, CCRCT, Scopus, Web of Science, and major gastroenterology conference abstracts through March 16, 2015. They evaluated randomized controlled trials and observational studies investigating the efficacy and safety of rifaximin for eradicating small intestinal bacterial overgrowth (SIBO) in adult patients.
What was found
Thirty-two studies involving 1,331 patients were included. The overall eradication rate was 70.8% (95% CI: 61.4–78.2; I² = 89.4%) by intention-to-treat analysis and 72.9% (95% CI: 65.5–79.8; I² = 87.5%) by per-protocol analysis. Meta-regression identified drug dose, study design, and co-therapy as independent predictors of higher eradication rates. The adverse event rate was 4.6% (95% CI: 2.3–7.5; I² = 63.6%). In the subset of 10 studies assessing symptoms, 67.7% of patients with eradicated SIBO achieved symptom improvement or resolution (95% CI: 44.7–86.9; I² = 91.3%).
Why it matters
This review provides quantitative pooled evidence supporting rifaximin for SIBO eradication while highlighting that common clinical practice relies on methodologically limited primary studies.
Limits
The primary studies were generally of poor quality and pooled both observational studies and RCTs. Substantial statistical heterogeneity was observed across eradication and symptom outcomes (I² > 87%). The abstract does not detail specific diagnostic criteria used to confirm SIBO, specific comparator regimens, or recurrence rates.
Cited by
- supports SIBO is typically treated using an antibiotic protocol.