Rifaximin: unique selective antibiotic for the treatment of gastrointestinal diseases

Abstract

The human gut microbiota has been a major focus of scientific research in recent years. Studies based on metagenomic methods have revealed the multifaceted abilities of gut microbes, from metabolic functions to immunomodulation, from antipathogenic activity to behavioral formation. Since the gut microbiota plays a crucial role in maintaining human health, more or less specific changes in the gut microbiota are associated with various gastrointestinal diseases. These data strongly support the use of gut microbiota modulators, such as antibiotics, prebiotics and probiotics, as the choice for almost all gastrointestinal disorders. The traditional use of antibiotics in clinical practice is to counteract local or systemic infections. It can be assumed that antibiotics have a detrimental effect on the intestinal ecology. However, this is not true for all antibiotics.Rifaximin is a non-systemic oral antibiotic derived from rifampin and is characterized by a broad spectrum of antibacterial activity against Gram-positive and negative, aerobic and anaerobic bacteria. Rifaximin was first approved in Italy in 1987 and then in many other countries of the world for the treatment of several gastrointestinal diseases. This review presents the pharmacology and pharmacodynamics of rifaximin, describing various actions beyond its antibacterial activity, such as altering virulence, preventing intestinal mucosal adhesion and bacterial translocation. Key studies on the different uses of rifaximin are also described. In addition, rifaximin has some anti-inflammatory effects with minimal impact on the overall composition of the gut microbiota. All of these properties make rifaximin a good candidate for the treatment of various gastrointestinal diseases.