ABSTRACT

Objectives

Over the past decades, rifaximin has been used to treat with small intestinal bacterial overgrowth (SIBO), however, the true efficacy remains unknown. This systematic review and meta-analysis was performed to assess the safety and efficacy of rifaximin in treating with patients with SIBO.

Methods

Embase, Pubmed, Cochrane Central Register of Controlled Trials, and Web of Science were searched from inception to April, 2021 for published randomized controlled trials (RCTs) and observational studies with or without comparable arms.

Results

A total of 21 observational studies and 5 RCTs involving 874 patients were included. The overall eradication rate according to intention-to-treat analysis (ITT) was 59% (95% CI: 50 to 69%; I² = 90.69%) and to per protocol analysis (PP) 63% (95% CI: 53 to 72%; I² = 90.32%). For 5 RCTs included comparing the efficacy between rifaximin and placebo or active controls, there was no significant difference (n = 203, risk ratio = 1.14, 95%CI: 0.59 to 2.19, P = 0.15, I² = 38%). Subgroup analysis and meta-regression indicated a dose-dependent eradication rate of rifaximin for SIBO.

Conclusion

Rifaximin is effective and safe in eradicating SIBO, with a dose-dependent efficacy and commonly associated with the improvement of the gastrointestinal symptoms and underlying diseases.

中文翻译：

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利福昔明治疗小肠细菌过度生长的疗效：系统评价和荟萃分析

摘要

目标

在过去的几十年里，利福昔明一直被用于治疗小肠细菌过度生长（SIBO），然而，真正的疗效仍然未知。这项系统回顾和荟萃分析旨在评估利福昔明治疗 SIBO 患者的安全性和有效性。

方法

从成立到 2021 年 4 月，对 Embase、Pubmed、Cochrane Central Register of Controlled Trials 和 Web of Science 进行了搜索，以获取已发表的随机对照试验 (RCT) 和具有或不具有可比臂的观察性研究。

结果

共纳入 21 项观察性研究和 5 项 RCT，涉及 874 名患者。根据意向治疗分析 (ITT) 的总体根除率为 59% (95% CI: 50 to 69%; I ²  = 90.69%) 和按照方案分析 (PP) 的总根除率为 63% (95% CI: 53 72%；I ²  = 90.32%)。对于 5 项 RCT，包括比较利福昔明与安慰剂或活性对照之间的疗效，没有显着差异（n = 203，风险比 = 1.14，95% CI：0.59 至 2.19，P = 0.15，I ²  = 38%）。亚组分析和元回归表明利福昔明对 SIBO 的根除率呈剂量依赖性。

结论

利福昔明根除SIBO有效且安全，具有剂量依赖性疗效，通常与胃肠道症状和基础疾病的改善有关。