A Randomized, Double-Blind, Placebo-Controlled Trial of Rifaximin, a Nonabsorbable Antibiotic, in the Treatment of Tropical Enteropathy

  title={A Randomized, Double-Blind, Placebo-Controlled Trial of Rifaximin, a Nonabsorbable Antibiotic, in the Treatment of Tropical Enteropathy},
  author={Indi Trehan and Robert J. Shulman and Ching Nan Ou and Kenneth M Maleta and Mark J Manary},
  journal={The American Journal of Gastroenterology},
OBJECTIVES:Tropical enteropathy is characterized by an increased urinary lactulose-to-mannitol (L:M) ratio on a site-specific sugar absorption test and is associated with increased intestinal permeability and decreased nutrient absorptive capacity. The etiology of tropical enteropathy is postulated to be intestinal bacterial overgrowth. This study tested the hypothesis that treatment with a nonabsorbable, broad-spectrum antibiotic, rifaximin, reduces the L:M ratio in rural Malawian children… 
Zinc or albendazole attenuates the progression of environmental enteropathy: a randomized controlled trial.
  • K. Ryan, K. Stephenson, M. Manary
  • Medicine
    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
  • 2014
Multiple micronutrient supplementation transiently ameliorates environmental enteropathy in Malawian children aged 12-35 months in a randomized controlled clinical trial.
The data suggest MNs can transiently ameliorate EE in rural African children, with the primary outcomes being the change in L:M after 12 and 24 wk of supplementation.
Supplementation With Lactoferrin and Lysozyme Ameliorates Environmental Enteric Dysfunction: A Double-Blind, Randomized, Placebo-Controlled Trial
INTRODUCTION: Environmental enteric dysfunction (EED) predisposes children throughout the developing world to high rates of systemic exposure to enteric pathogens and stunting. Effective
A Combined Intervention of Zinc, Multiple Micronutrients, and Albendazole Does Not Ameliorate Environmental Enteric Dysfunction or Stunting in Rural Malawian Children in a Double-Blind Randomized Controlled Trial.
The combined usage of albendazole, zinc, and a daily multiple micronutrient powder did not decrease EED or stunting in this population of agrarian children 12-35 mo old in rural Malawi.
Mesalazine in the initial management of severely acutely malnourished children with environmental enteric dysfunction: a pilot randomized controlled trial
Intestinal inflammation in EED is non-essential for mucosal homeostasis and is at least partly maladaptive; further trials of gut-specific immunomodulatory therapies targeting host inflammatory activation in order to optimize the growth benefits of nutritional rehabilitation and to address stunting are warranted.
A multicenter, randomized controlled comparison of three renutrition strategies for the management of moderate acute malnutrition among children aged from 6 to 24 months (the MALINEA project)
This study will provide new insights for the treatment of MAM, as well as original data on the modulation of gut microbiota during the renutrition process to support (or not) the microbiota hypothesis of malnutrition.
High dose multiple micronutrient supplementation improves villous morphology in environmental enteropathy without HIV enteropathy: results from a double-blind randomised placebo controlled trial in Zambian adults
There was a clear difference in response depending on HIV status, suggesting that EE with superimposed HIV enteropathy may be a distinct pathophysiological condition and Nutritional intervention may selectively influence villous compartment remodelling.
Lactoferrin and lysozyme to reduce environmental enteric dysfunction and stunting in Malawian children: study protocol for a randomized controlled trial
A prospective randomized placebo-controlled parallel-group randomized controlled trial is conducted to determine if a daily supplement of lactoferrin and lysozyme, two important proteins found in breast milk, can decrease the burden of EED and stunting in rural Malawian children aged 12–23 months old.
Tryptophan, glutamine, leucine, and micronutrient supplementation improves environmental enteropathy in Zambian adults: a randomized controlled trial
In this phase 2 trial, AA supplementation protected against a decline in VH over the supplementation period, and improved barrier function when combined with micronutrients.


Effect of Lactobacillus GG on intestinal integrity in Malawian children at risk of tropical enteropathy.
Treatment of 3-5-y-old Malawian children with the probiotic Lactobacillus GG for 30 d had no effect on the intestinal integrity and the primary outcomes were the ratios of urinary lactulose to mannitol and of urinary sucrose to lactULose excretion.
Efficacy of Rifaximin, a Nonabsorbed Oral Antibiotic, in the Treatment of Small Intestinal Bacterial Overgrowth
Rifaximin in a dose of 800 mg per day for 4 weeks was safe and effective treatment in reducing symptoms in patients with SIBO of multiple etiologies, especially when diarrhea was the dominant symptom and normalized the glucose breath test in approximately 50% of patients.
Rifaximin treatment of pathogen-negative travelers' diarrhea.
Rifaximin was effective in treating the illness without associated side effects, consistent with the hypothesis that undetected bacterial pathogens are the most likely cause of travelers' diarrhea without definable cause.
Epidemiology of altered intestinal permeability to lactulose and mannitol in Guatemalan infants.
Age, feeding practices, low weight-for-age, low serum iron concentration, and recent diarrhea were all associated with altered intestinal function in this group of Guatemalan infants.
Age-related association of small intestinal mucosal enteropathy with nutritional status in rural Gambian children.
It appears that the small bowel enteropathy previously described in Gambian infants persists through to adulthood, and the relationship between attained height and L:M permeability raises the possibility that enteropathy may continue to limit growth throughout childhood and puberty.
Rifaximin--a novel antimicrobial for enteric infections.
Rifaximin: a novel nonabsorbed rifamycin for gastrointestinal disorders.
  • J. Adachi, H. Dupont
  • Medicine, Biology
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 2006
Rifaximin has been demonstrated to reduce the duration of traveler's diarrhea secondary to noninvasive bacterial pathogens and recently has been shown to reduceThe occurrence of the disease when used for chemoprophylaxis.
Chronic T Cell-Mediated Enteropathy in Rural West African Children: Relationship with Nutritional Status and Small Bowel Function
Although small bowel architecture was independent of nutritional status, T cell numbers rose and B cell numbers fell with worsening nutrition, and mucosal cytokine production became biased toward a proinflammatory response, with progressive decrease of transforming growth factor-β expression.
Lactulose-mannitol intestinal permeability test in children with diarrhea caused by rotavirus and cryptosporidium. Diarrhea Working Group, Peru.
The results indicate that increased intestinal permeability caused by rotavirus or cryptosporidium infections in Peruvian infants less than 36 months of age is a significant but reversible phenomenon.
Antimicrobials in the Management of Inflammatory Bowel Disease
Preliminary data suggest that rifaximin may be beneficial in the treatment of active ulcerative colitis, mild to moderate CD as well as prevention of post-operative recurrence of CD.