gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1992Research ArticleЛЕКЦИИ И ОБЗОРЫLECTURES AND REVIEWSСовременные возможности применения рифаксимина в гастроэнтерологииRifaximin in gastroenterology: state-of-the-artШептулинА. А.SheptulinA. A.ТорресЭ. А.TorresE. A.2008260920081851722Copyright © Шептулин А.А., Торрес Э.А., 20082008Шептулин А.А., Торрес Э.А.Sheptulin A.A., Torres E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1992

Цель обзора. Показать особенности фармакокинетики и фармакодинамики, а также возможности клинического применения невсасывающегося антибиотика рифаксимина.Последние данные литературы Невса­сывающийся антибиотик рифаксимин обладает целым рядом преимуществ в отношении фармакокинетики и фармакодинамики по сравнению с системно действующими антибиотиками. В настоящее время очерчен круг гастроэнтерологических заболеваний, при которых эффективность рифаксимина может считаться доказанной. К ним относятся: инфекционная диарея (включая диарею путешественников), синдром избыточного роста бактерий, дивертикулярная болезнь кишечника, хронические воспалительные заболевания кишечника, печеночная энцефалопатия. Этот круг может быть расширен после проведения дополнительных клинических исследований возможности применения рифаксимина и при других заболеваниях (например, диарее, обусловленной Cl. difficile, функциональных расстройствах кишечника, для эрадикации инфекции H. pylori и др.).Заключение. Альфа­Нормикс (рифаксимин) является высокоэффективным и безопасным невсасывающимся антибиотиком, который может найти широкое применение при лечении различных гастроэнтерологических заболеваний.

The aim of review

The aim of review. To demonstrate features of pharmakokinetics and pharmacodynamics, as well as options of clinical application of nonabsorbable antibiotic rifaximin.

Recent literature data

Recent literature data. Nonabsorbable antibiotic rifaximin has a lot of advantages from the point of view of pharmakokinetics and pharmacodynamics in comparison to systemically acting drugs. Now the range of gastroenterological diseases with proven efficacy of rifaximin can be outlined. They include: contagious diarrhea (including travelers’ diarrhea), bacterial overgrowth syndrome, diverticular disease of intestine, chronic inflammatory bowel diseases, hepatic encephalopathy. This range can grow wider after additional studies of potential of rifaximin application at other diseases (for example, Cl. difficile–related diarrhea, functional disorders of intestine, eradication of H.pylori infection, etc.).

Conclusion

Conclusion. Alpha-normix (rifaximin) is highly effective and safe nonabsorbable antibiotic which broad spectrum of application, that can be applied for treatment of various gastroenterological diseases.

рифаксиминфармакокинетикафармакодинамикаприменение в гастроэнтерологииrifaximinpharmakokineticspharmacodynamicsapplication in gastroenterologyReferencesAbdelrazeg A.S., Kelly S.M., Lund J.N., Leveson S.H. Rifaximin-ciprofloxacin combination therapy is effective in chronic active pouchitis // Colorectal Dis. – 2005. – Vol. 7. – P. 182–186.Abdelrazeg A.S., Kelly S.M., Lund J.N., Leveson S.H. Rifaximin-ciprofloxacin combination therapy is effective in chronic active pouchitis // Colorectal Dis. – 2005. – Vol. 7. – P. 182–186.Amenta M., Dalle Nogare E.R., Colomba C. et al. Intestinal protozoa in HIV-infected patients: effect of rifaximin in Cryptosporidium parvum and Blastocistis hominis infections // J. Chemother. – 1999. – Vol. 11. – P. 391–395.Amenta M., Dalle Nogare E.R., Colomba C. et al. Intestinal protozoa in HIV-infected patients: effect of rifaximin in Cryptosporidium parvum and Blastocistis hominis infections // J. Chemother. – 1999. – Vol. 11. – P. 391–395.Campieri M., Rizello F., Venturi A. et al. Combination of antibiotic and probiotic treatment is efficacious in prophylaxis of post-operative recurrence of Crohn’s disease: a randomized controlled study vs. mesalamine // Gastroenterology. – 2000. – Vol. 118. – P. 781.Campieri M., Rizello F., Venturi A. et al. Combination of antibiotic and probiotic treatment is efficacious in prophylaxis of post-operative recurrence of Crohn’s disease: a randomized controlled study vs. mesalamine // Gastroenterology. – 2000. – Vol. 118. – P. 781.Castelli F., Saleri N., Tomasoni L.R., Carosi G. Prevention and treatment of traveler’s diarrhea. Focus on antimicrobial agents // Bacterial flora in digestive disease. Focus on rifaximin / Eds. C. Scarpignato, A. Lanas. – Basel: Karger, 2006. – P. 174–190.Castelli F., Saleri N., Tomasoni L.R., Carosi G. Prevention and treatment of traveler’s diarrhea. Focus on antimicrobial agents // Bacterial flora in digestive disease. Focus on rifaximin / Eds. C. Scarpignato, A. Lanas. – Basel: Karger, 2006. – P. 174–190.De Gastro R., Domenichelli V., Di Lorenzo F.P. et al. Rifaximin treatmemnt for acute recurrent diarrhea in children with genitourinary disorders // Curr. Ther. Res. – 1998. – Vol. 59. – P. 746–752.De Gastro R., Domenichelli V., Di Lorenzo F.P. et al. Rifaximin treatmemnt for acute recurrent diarrhea in children with genitourinary disorders // Curr. Ther. Res. – 1998. – Vol. 59. – P. 746–752.Descombe J.J., Dubourg D., Picard M. et al. Pharmacokinetic study of rifaximin after oral administration in healthy volunteers // Int. J. Clin. Pharmacol. Res. – 1994. – Vol. 14. – P. 51–56.Descombe J.J., Dubourg D., Picard M. et al. Pharmacokinetic study of rifaximin after oral administration in healthy volunteers // Int. J. Clin. Pharmacol. Res. – 1994. – Vol. 14. – P. 51–56.Di Stefano M., Malservisi S., Veneto G. et al. Rifaximin versus chlortetracycline in the short-term treatment of small intestinal bacterial overgrowth // Aliment. Pharmacol. Ther. – 2000. – Vol. 14. – P. 551–556.Di Stefano M., Malservisi S., Veneto G. et al. Rifaximin versus chlortetracycline in the short-term treatment of small intestinal bacterial overgrowth // Aliment. Pharmacol. Ther. – 2000. – Vol. 14. – P. 551–556.Di Stefano M., Strocchi A.S., Malservisi S. et al. Non-absorbable antibiotics for managing intestinal gas production and gas-related symptoms // Aliment. Pharmacol. Ther. – 2000. – Vol. 14. – P. 1001–1008.Di Stefano M., Strocchi A.S., Malservisi S. et al. Non-absorbable antibiotics for managing intestinal gas production and gas-related symptoms // Aliment. Pharmacol. Ther. – 2000. – Vol. 14. – P. 1001–1008.DuPont H.L. Community-acquired diarrheal disease in western countries: applications of nonabsorbable oral antibiotic therapy // Adv. Stud. Med. – 2003. – Vol. 3 (suppl. A). – P. 945–950.DuPont H.L. Community-acquired diarrheal disease in western countries: applications of nonabsorbable oral antibiotic therapy // Adv. Stud. Med. – 2003. – Vol. 3 (suppl. A). – P. 945–950.DuPont H.L., Ericsson C.D., Mathewson J.J. et al. Rifaximin: a nonabsorbed antimicrobial in the therapy of travelers’ diarrhea // Digestion. – 1998. – Vol. 59. – P. 708–714.DuPont H.L., Ericsson C.D., Mathewson J.J. et al. Rifaximin: a nonabsorbed antimicrobial in the therapy of travelers’ diarrhea // Digestion. – 1998. – Vol. 59. – P. 708–714.DuPont H.L., Zhi-Dong Jiang, Okhuysen P.C. et al. A randomized, double-blind, placebo-controlled trial of rifaximin to prevent travelers’ diarrhea // Ann. Intern. Med. – 2005. – Vol. 142. – P. 805–812.DuPont H.L., Zhi-Dong Jiang, Okhuysen P.C. et al. A randomized, double-blind, placebo-controlled trial of rifaximin to prevent travelers’ diarrhea // Ann. Intern. Med. – 2005. – Vol. 142. – P. 805–812.Festi D., Vestito A., Mazzella G. et al. Management of hepatic encephalopathy: focus on antibiotic therapy // Bacterial flora in digestive disease. Focus on rifaximin / Eds. C. Scarpignato, A. Lanas. – Basel: Karger, 2006. – P. 148–161.Festi D., Vestito A., Mazzella G. et al. Management of hepatic encephalopathy: focus on antibiotic therapy // Bacterial flora in digestive disease. Focus on rifaximin / Eds. C. Scarpignato, A. Lanas. – Basel: Karger, 2006. – P. 148–161.Frieri G., Pimpo M.T., Scarpignato C. Management of colonic diverticular disease // Bacterial flora in digestive disease. Focus on rifaximin / Eds. C. Scarpignato, A. Lanas. – Basel: Karger, 2006. – P. 89–103.Frieri G., Pimpo M.T., Scarpignato C. Management of colonic diverticular disease // Bacterial flora in digestive disease. Focus on rifaximin / Eds. C. Scarpignato, A. Lanas. – Basel: Karger, 2006. – P. 89–103.Gasbarrini A., Gasbarrini G., Pelosini I., Scarpignato C. Eradication of Helicobacter pylori: are rifaximin-based regiments effective? // Bacterial flora in digestive disease. Focus on rifaximin / Eds. C. Scarpignato, A. Lanas. – Basel: Karger, 2006. – P. 207–220.Gasbarrini A., Gasbarrini G., Pelosini I., Scarpignato C. Eradication of Helicobacter pylori: are rifaximin-based regiments effective? // Bacterial flora in digestive disease. Focus on rifaximin / Eds. C. Scarpignato, A. Lanas. – Basel: Karger, 2006. – P. 207–220.Giacometti A., Ferrieri A., Cirioni O. et al. Treatment of diarrhea in AIDS patients: double-blind clinical trial // Farmaci & Terapia Int. J. Drugs Ther. – 1993. – Vol. 10. – P. 107–109.Giacometti A., Ferrieri A., Cirioni O. et al. Treatment of diarrhea in AIDS patients: double-blind clinical trial // Farmaci & Terapia Int. J. Drugs Ther. – 1993. – Vol. 10. – P. 107–109.Gionchetti P., Rizello F, Ferrieri A. et al. Rifaximin in patients with moderate or severe ulcerative colitis refractory to steroid-treatment; a double-blind, placebo-controlled trial // Dig. Dis. Sci. – 1999. – Vol. 44. – P. 1220–1221.Gionchetti P., Rizello F, Ferrieri A. et al. Rifaximin in patients with moderate or severe ulcerative colitis refractory to steroid-treatment; a double-blind, placebo-controlled trial // Dig. Dis. Sci. – 1999. – Vol. 44. – P. 1220–1221.Gionchetti P., Rizello F., Lammers K.M. et al. Antimicrobials in the management of inflammatory bowel disease // Bacterial flora in digestive disease. Focus on rifaximin / Eds. C. Scarpignato, A. Lanas. – Basel: Karger, 2006. – P. 120–134.Gionchetti P., Rizello F., Lammers K.M. et al. Antimicrobials in the management of inflammatory bowel disease // Bacterial flora in digestive disease. Focus on rifaximin / Eds. C. Scarpignato, A. Lanas. – Basel: Karger, 2006. – P. 120–134.Guslandi M., Giollo P., Testoni P.A. Corticosteroid-sparing effect of rifaximin, a nonabsorbable oral antibiotic in active ulcerative colitis: preliminary clinical experience // Curr. Ther. Res. – 2004. – Vol. 65. – P. 292–296.Guslandi M., Giollo P., Testoni P.A. Corticosteroid-sparing effect of rifaximin, a nonabsorbable oral antibiotic in active ulcerative colitis: preliminary clinical experience // Curr. Ther. Res. – 2004. – Vol. 65. – P. 292–296.Jiang Z.D., DuPont H.L. Rifaximin: in vitro and in vivo antibacterial activity – a review // Chemotherapy. – 2005. – Vol. 51 (suppl. 1). – P. 67–72.Jiang Z.D., DuPont H.L. Rifaximin: in vitro and in vivo antibacterial activity – a review // Chemotherapy. – 2005. – Vol. 51 (suppl. 1). – P. 67–72.Johnson S., Schriever Ch., Galang M. Interruption of recurrent Clostridium difficile associated diarrhea episodes by serial therapy with vancomycin and rifaximin. Brief report // Clin. Infect. Dis. – 2007. – Vol. 44. – P. 1–3.Johnson S., Schriever Ch., Galang M. Interruption of recurrent Clostridium difficile associated diarrhea episodes by serial therapy with vancomycin and rifaximin. Brief report // Clin. Infect. Dis. – 2007. – Vol. 44. – P. 1–3.Lanas A., Scarpignato C. Microbial flora in NSAID-induced intestinal damage. A role for antibiotics // Bacterial flora in digestive disease. Focus on rifaximin / Eds. C. Scarpignato, A. Lanas. – Basel: Karger, 2006. – P. 221–247.Lanas A., Scarpignato C. Microbial flora in NSAID-induced intestinal damage. A role for antibiotics // Bacterial flora in digestive disease. Focus on rifaximin / Eds. C. Scarpignato, A. Lanas. – Basel: Karger, 2006. – P. 221–247.Latella G., Pimpo M.T., Sottili S. et al. Rifaximin improves symptoms of acquired uncomplicated diverticular disease of the colon // Int. J. Colorectal Dis. – 2003. – Vol. 18. – P. 55–62.Latella G., Pimpo M.T., Sottili S. et al. Rifaximin improves symptoms of acquired uncomplicated diverticular disease of the colon // Int. J. Colorectal Dis. – 2003. – Vol. 18. – P. 55–62.Lin H.C. Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome // JAMA. – 2004. – Vol. 292. – P. 852–858.Lin H.C. Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome // JAMA. – 2004. – Vol. 292. – P. 852–858.Lukas M., Konecny M., Zboril V. Rifaximin in patients with mild to moderate activity of ulcerative colitis: An open label study // Gastroenterology. – 2002. – Vol. 122 (suppl. 1). – P. 434.Lukas M., Konecny M., Zboril V. Rifaximin in patients with mild to moderate activity of ulcerative colitis: An open label study // Gastroenterology. – 2002. – Vol. 122 (suppl. 1). – P. 434.Lupascu A., Gabrielli M., Lauritano C. et al. Hydrogen glucose breath test to detect small intestinal overgrowth: a prevalence case-control study in irritable bowel syndrome // Aliment. Pharmacol. Ther. – 2005. – Vol. 22. – P. 1157–1160.Lupascu A., Gabrielli M., Lauritano C. et al. Hydrogen glucose breath test to detect small intestinal overgrowth: a prevalence case-control study in irritable bowel syndrome // Aliment. Pharmacol. Ther. – 2005. – Vol. 22. – P. 1157–1160.Mas A. Hepatic encephalopathy: from pathophysiology to treatment // Bacterial flora in digestive disease. Focus on rifaximin / Eds. C. Scarpignato, A. Lanas. – Basel: Karger, 2006. – P. 135–147.Mas A. Hepatic encephalopathy: from pathophysiology to treatment // Bacterial flora in digestive disease. Focus on rifaximin / Eds. C. Scarpignato, A. Lanas. – Basel: Karger, 2006. – P. 135–147.Mas A., Rhodes J., Sunyer L. et al. Comparison of rifaximin and lactiol in the treatment of acute hepatic encephalopathy: results of randomized, double-blind, double-dummy, controlled clinical trial // J. Hepatol. – 2003. – Vol. 38. – P. 51–58.Mas A., Rhodes J., Sunyer L. et al. Comparison of rifaximin and lactiol in the treatment of acute hepatic encephalopathy: results of randomized, double-blind, double-dummy, controlled clinical trial // J. Hepatol. – 2003. – Vol. 38. – P. 51–58.McCallum R., Schultz C., Sostarich S. Evaluating the role of small intestinal bacterial overgrowth in diarrhea predominant irritable bowel syndrome patients using the glucose breath test // Gastroenterology. – 2005. – Vol. 128 (suppl. 2). – P. 460.McCallum R., Schultz C., Sostarich S. Evaluating the role of small intestinal bacterial overgrowth in diarrhea predominant irritable bowel syndrome patients using the glucose breath test // Gastroenterology. – 2005. – Vol. 128 (suppl. 2). – P. 460.Papi C., Ciaco A., Koch M. et al. Efficacy of rifaximin in the treatment of symptomatic diverticular disease of the colon. A multicentre double-blind placebo-controlled trial // Aliment. Pharmacol. Ther. – 1995. – Vol. 9. – P. 33–39.Papi C., Ciaco A., Koch M. et al. Efficacy of rifaximin in the treatment of symptomatic diverticular disease of the colon. A multicentre double-blind placebo-controlled trial // Aliment. Pharmacol. Ther. – 1995. – Vol. 9. – P. 33–39.Papi C., Ciaco A., Koch M. et al. Efficacy of rifaximin on symptoms of uncomplicated diverticular disease of the colon. A pilot multicentre open trial // Ital. J. Gastroenterol. – 1992. – Vol. 24. – P. 452–456.Papi C., Ciaco A., Koch M. et al. Efficacy of rifaximin on symptoms of uncomplicated diverticular disease of the colon. A pilot multicentre open trial // Ital. J. Gastroenterol. – 1992. – Vol. 24. – P. 452–456.Porta E., Germano A., Ferrieri A., Koch M. The natural history of diverticular disease of the colon: a role for antibiotics in preventing complications? A retrospective study // Eur. Rev. Med. Pharmacol. Sci. – 1994. – Vol. 16. – P. 33–39.Porta E., Germano A., Ferrieri A., Koch M. The natural history of diverticular disease of the colon: a role for antibiotics in preventing complications? A retrospective study // Eur. Rev. Med. Pharmacol. Sci. – 1994. – Vol. 16. – P. 33–39.Rizello F., Gionchetti P., Venturi A. et al. Rifaximin systemic absorbtion in patients with ulcerative colitis // Eur. J. Clin. Pharmacol. – 1998. – Vol. 54. – P. 91–93.Rizello F., Gionchetti P., Venturi A. et al. Rifaximin systemic absorbtion in patients with ulcerative colitis // Eur. J. Clin. Pharmacol. – 1998. – Vol. 54. – P. 91–93.Scarpignato C., Pelosini I. Experimental and clinical pharmacology of rifaximin, a gastrointestinal selective antibiotic // Bacterial flora in digestive disease. Focus on rifaximin / Eds. C. Scarpignato, A. Lanas. – Basel: Karger, 2006. – P. 15–39.Scarpignato C., Pelosini I. Experimental and clinical pharmacology of rifaximin, a gastrointestinal selective antibiotic // Bacterial flora in digestive disease. Focus on rifaximin / Eds. C. Scarpignato, A. Lanas. – Basel: Karger, 2006. – P. 15–39.Scarpignato C., Pelosini I. Rifaximin, a poorly absorbed antibiotic: pharmacology and clinical potential // Chemotherapy. – 2005. – Vol. 51 (suppl. 1). – P. 36–66.Scarpignato C., Pelosini I. Rifaximin, a poorly absorbed antibiotic: pharmacology and clinical potential // Chemotherapy. – 2005. – Vol. 51 (suppl. 1). – P. 36–66.Shafran I., Johnson L. An open-label evaluation of rifaximin in the treatment of active Crohn’s disease // Curr. Med. Res. Opin. – 2005. – Vol. 21. – P. 1165–1169.Shafran I., Johnson L. An open-label evaluation of rifaximin in the treatment of active Crohn’s disease // Curr. Med. Res. Opin. – 2005. – Vol. 21. – P. 1165–1169.Steffen R., Sack D.A., Riopel L. et al. Therapy of travelers diarrhea with rifaximin on various continents // Am. J. Gastroenterol. – 2003. – Vol. 98. – P. 1073–1078.Steffen R., Sack D.A., Riopel L. et al. Therapy of travelers diarrhea with rifaximin on various continents // Am. J. Gastroenterol. – 2003. – Vol. 98. – P. 1073–1078.Surawicz C.M. Antibiotics-associated diarrhea and pseudomembranous colitis: are they less common with poorly absorbed antimicrobials? // Chemotherapy. – 2005. – Vol. 51 (suppl. 1). – P. 81–89.Surawicz C.M. Antibiotics-associated diarrhea and pseudomembranous colitis: are they less common with poorly absorbed antimicrobials? // Chemotherapy. – 2005. – Vol. 51 (suppl. 1). – P. 81–89.Taylor D., Bourgeois A.L., Ericsson Ch.D. A randomized, double-blind, multicenter study of rifaximin compared with placebo and with ciprofloxacin in the treatment of travelers’ diarrhea // Am. J. Trop. Med. Hyg. – 2006. – Vol. 74. – P. 1060–1066.Taylor D., Bourgeois A.L., Ericsson Ch.D. A randomized, double-blind, multicenter study of rifaximin compared with placebo and with ciprofloxacin in the treatment of travelers’ diarrhea // Am. J. Trop. Med. Hyg. – 2006. – Vol. 74. – P. 1060–1066.Williams R., Rizzello F., Venturi A. et al. Antibiotic of the efficacy and safety of rifaximin in the treatment of hepatic encephalopathy: a double-blind, randomized, dose-finding multi-centre study // Eur. J. Gastroenterol. Hepatol. – 2000. – Vol. 12. – P. 203–208.Williams R., Rizzello F., Venturi A. et al. Antibiotic of the efficacy and safety of rifaximin in the treatment of hepatic encephalopathy: a double-blind, randomized, dose-finding multi-centre study // Eur. J. Gastroenterol. Hepatol. – 2000. – Vol. 12. – P. 203–208.Wingate D., Phillips S.E., Lewis S.J. et al. Guidelines for adults on self-medication for the treatment of acute diarrhea // Aliment. Pharmacol. Ther. – 2001. – Vol. 15. – P. 773–782.Wingate D., Phillips S.E., Lewis S.J. et al. Guidelines for adults on self-medication for the treatment of acute diarrhea // Aliment. Pharmacol. Ther. – 2001. – Vol. 15. – P. 773–782.

The authors declare that there are no conflicts of interest present.