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| |  Rifaximin Shows No Effect on Tropical Enteropathy: Presented at PAS By Jill Stein BALTIMORE, Md -- May 7, 2009 -- A 7-day course of the semisynthetic, nonabsorbable antibiotic rifaximin has no effect on intestinal integrity in children living in an area where tropical enteropathy is presumed to be common, according to study results reported here at the 2009 Pediatric Academic Societies (PAS) Annual Meeting. Indi Trehan, MD, Washington University School of Medicine, St. Louis, Missouri, and colleagues randomised 144 children to 7 days of treatment with rifaximin or placebo. The children were 3 to 5 years old and lived in Limela, Malawi, a rural area where the local diet consists primarily of maize supplemented with small amounts of fish. Children with severe acute malnutrition were excluded and enrolled in a home-based therapeutic feeding program. Tropical enteropathy, which is characterised by a diffuse villous atrophy of the small bowel and subclinical malabsorption, is associated with stunting in otherwise healthy children younger than 5 years of age in developing countries. Tropical enteropathy is hypothesised to be caused by changes in populations of enteric flora, leading to small-bowel bacterial overgrowth. Rifaximin is effective against diverse clinical problems provided by alternations in the gut microbiota (including small-intestinal bacterial overgrowth). The study tested the hypothesis that rifaximin would reduce the lactulose-to-mannitol (L:M) ratio in the study population, Dr. Trehan explained here in a presentation on May 4. Intestinal function and integrity were measured by a site-specific sugar-absorption test both before and after treatment. The L:M ratio was measured before treatment and again 28 days after the start of the intervention. The primary outcome was the change in the L:M ratio. Overall, 76% of the participants had tropical enteropathy at enrolment, defined as an L:M ratio of 0.10 mmol/L or greater. Children who received rifaximin did not demonstrate an improvement in their L:M ratio at follow-up, compared with placebo-treated children, nor were there significant differences between rifaximin-treated children and placebo-treated children in the excretion of lactulose (0.28 vs 0.29 mmol/L), mannitol (7.9 vs 9.3 mmol/L), sucralose (0.48 vs 0.51 mmol/L), or sucrose (0.054 vs 0.058 mmol/L), or in the sucrose-to-lactulose and sucralose-to-lactulose ratios. Overall, Dr. Trehan concluded, the results suggest that the hypothesis that overgrowth or disruption of the normal bacterial microbiota in the small bowel leads to tropical enteropathy should be reconsidered.
[Presentation title: Randomized, Double-Blind, Placebo-Controlled Trial of Rifaximin, a Non-Absorbable Antibiotic, in the Treatment of Sub-Clinical Tropical Enteropathy. Abstract 4334.176]
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