CLINICAL REVIEWSRifaximin in the Treatment of Irritable Bowel Syndrome Is There a High Risk for Development of Antimicrobial Resistance?Farrell, David J. PhD, D(ABMM)Author Information JMI Laboratories, North Liberty, IA D.J.F. was paid consultancy fees in the field of antimicrobial resistance by Prometheus Laboratories Inc., San Diego, CA. Prometheus Laboratories Inc. does not own and does not participate in the marketing or sales of rifaximin. Prometheus Laboratories Inc. manufactures Helidac, which is used for the treatment of duodenal ulcers associated with Helicobacter pylori infections. Editorial and journal submission support for this article was provided by Rebecca Watson and Anthony Stonehouse of Watson & Stonehouse Enterprises, LLC, and funded by Prometheus Laboratories Inc., San Diego, CA. Reprints: David J. Farrell, PhD, D(ABMM), Public Health Ontario, Toronto Laboratory, 81 Resources Road, Toronto Ontario, Canada M9P 3T1 (e-mail: [email protected]). Journal of Clinical Gastroenterology: March 2013 - Volume 47 - Issue 3 - p 205-211 doi: 10.1097/MCG.0b013e31827559a3 Buy Metrics Abstract Irritable bowel syndrome (IBS), a chronic, nonfatal illness is commonly encountered in clinical practice; however, treatment options are limited and often ineffectual. Despite this, there is increasing evidence that bacterial overgrowth in the bowel (dysbiosis) may be an etiological factor in IBS. This has lead to studies in which the antibiotic agent rifaximin has been used to reduce the microbial burden in the bowel, to some extent alleviating the symptoms of IBS. Rifaximin is a member of the rifamycin class of antibiotics, which when administered orally has the distinctions of being gut specific coupled with poor systemic absorption, characteristics that are suggested to limit the development of bacterial resistance. The rifamycins are currently used to treat serious human diseases including tuberculosis, meningococcal disease, methicillin-resistant Staphylococcus aureus and Clostridium difficile infections. The use of rifamycins in the treatment of these diseases is associated with the development of antibiotic resistance over time. When considering the importance of the rifamycins in the treatment of serious human diseases, the large number of patients affected by IBS, and the lack of scientific evidence available on the development of antibiotic resistance to rifaximin over the long-term when used in the gut, it is advisable that the use of rifaximin as a therapy for IBS should be limited to single, acute, short-term treatment. © 2013 Lippincott Williams & Wilkins, Inc.