Summary
Some patients with bloating who have IBS may have some component of bacterial overgrowth, which may be responsive to a non-absorbable antibiotic, such as Xifaxan. Given how difficult is this disorder often to treat, this may be another therapeutic option on how to alleviate symptoms in some patients with this disorder.
Analysis
Would make the following comments:
1. Not all IBS patients are alike. The patients who may benefit may represent a subset of patients with IBS. Determining this is going to be mostly on clinical grounds, i.e. by taking a history, as in the community, Lactulose breath tests are not readily available in a community practice at this time. The decision to use Xifaxan will be made by starting that patient on empiric therapy, assuming it is likely in one's clinical judgement that that particular patient is likely to respond.
2. The dosage of Xifaxan used to treat bacterial overgrowth is significantly higher than the approved dosage used to treat traveler's diarrhea. It is often difficult to get third party payors to pay for an appropriate dosage at the present time, and this can limit one's ability to use what may be a very novel therapy. This most likely may not change until this indication becomes FDA approved.
