Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Lupin, Norgine, ASKA Pharma - LARVOL DELTA

Increased risk of antimicrobial resistance in patients with cirrhosis and hepatic encephalopathy using rifaximin. (PubMed, Nat Commun) - "We demonstrate a two-fold AMR risk associated with rifaximin use (HR = 1.89; 95% CI = 1.49-2.40), with significantly increased risks of vancomycin resistance (HR = 2.52; 95% CI = 1.64-3.88) and multidrug resistance (HR = 2.31; 95% CI = 1.38-3.85). Notably, patients receiving other antibiotics prior to rifaximin treatment exhibit greater AMR risks. These findings challenge the conventional view of rifaximin as a low-risk intervention and support mechanistic evidence linking rifaximin exposure to cross-resistance against critical antibiotics with real-world evidence."

Journal • CNS Disorders • Fibrosis • Hepatic Encephalopathy • Immunology • Infectious Disease • Septic Shock

Targeting gut microbiota in liver disease: A pharmacological approach for hepatic encephalopathy and beyond. (PubMed, World J Gastrointest Pharmacol Ther) - "This review explored the latest therapeutic strategies aimed at modulating gut microbiota in liver disease, focusing on traditional approaches such as non-absorbable disaccharides (lactulose, lactitol), antibiotics (rifaximin), and probiotics as well as novel interventions, including postbiotics, synbiotics, and fecal microbiota transplantation. We also discussed the implications of gut microbiota modulation in conditions beyond HE, such as metabolic dysfunction-associated steatotic liver disease and cirrhosis. By integrating gut microbiota-targeted therapies into liver disease management, we may develop more effective, personalized approaches to improve patient outcomes and reduce complications."

Journal • Review • CNS Disorders • Cognitive Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology • Inflammation • Liver Cirrhosis • Metabolic Disorders • Metabolic Dysfunction-Associated Steatotic Liver Disease • Transplantation

The Efficacy of Probiotics as an Adjunct to Treatment of SIBO With Rifaximin (clinicaltrials.gov) - P=N/A | N=129 | Completed | Sponsor: Pomeranian Medical University Szczecin | Recruiting ➔ Completed | Trial completion date: Apr 2025 ➔ Aug 2025

Trial completion • Trial completion date • Gastrointestinal Disorder

Therapeutic strategies for the prevention of acute diverticulitis according to the Diverticular Inflammation and Complication Assessment endoscopic score: a post hoc analysis of a prospective international study. (PubMed, Eur J Gastroenterol Hepatol) - "Mesalamine may be a better alternative in patients classified as DICA 2; however, its benefit over no treatment remains uncertain."

Journal • Retrospective data • Gastrointestinal Disorder • Inflammation

Occam's Razor or Hickam's Dictum: Delayed Onset of Pembrolizumab-Induced Podocytopathy and Acute Interstitial Nephritis After Cessation of the Drug (KIDNEY WEEK 2025) - "Medications included levothyroxine, duloxetine, and rifaximin. Our patient showed favorable response to prednisone, with marked improvement in both proteinuria and acute kidney injury (AKI). Continued vigilance for AKI and proteinuria is required even after the ICI is stopped."

Acute Kidney Injury • Glomerulonephritis • Nephrology • Renal Disease • Squamous Cell Carcinoma • Squamous Cell Carcinoma of Unknown Primary

Reevaluating rifaximin prophylaxis in severe acute pancreatitis: A call for methodological refinement and microbiome-centric endpoints. (PubMed, Pancreatology) - No abstract available

Journal • Pancreatitis

Small Intestinal Bacterial Overgrowth in Children with Short Bowel Syndrome. (PubMed, Children (Basel)) - "Management involves antibiotics like rifaximin and metronidazole, alongside strategies to address anatomical dysfunction, optimize nutrition, and prevent recurrence...Given the chronic and recurrent nature of SIBO in SBS, a multidisciplinary approach is essential, integrating gastroenterological, surgical, and nutritional care to effectively manage the condition. Future research should focus on improving diagnostic methods, refining treatment protocols, and exploring targeted therapies to enhance outcomes and quality of life for affected children."

Journal • Review • Gastrointestinal Disorder • Metabolic Disorders • Short Bowel Syndrome

Quantifying treatment value under IRA: a case study of rifaximin for the treatment of overt hepatic encephalopathy using QALY and non-QALY measures. (PubMed, J Med Econ) - "A cost-effectiveness analysis evaluated the economic value of rifaximin ± lactulose versus standard of care ± lactulose in preventing recurrent OHE in adults over a lifetime horizon from US payer and societal perspectives. After incorporating societal costs, ICERs improved to $43,908/QALY, $41,992/HYT, $49,259/evLYG, and $43,332/GRA-QALY. Rifaximin is a cost-effective treatment for preventing OHE recurrence in adults using QALY and non-QALY health benefit measures."

HEOR • Journal • CNS Disorders • Hepatic Encephalopathy • Transplantation

En kvinne i 40-årene med fallende bevissthetsnivå etter oppstart av sondeernæring. (PubMed, Tidsskr Nor Laegeforen) - "She was intubated and transferred to the ICU for treatment with dialysis, sodium benzoate, lactulose and rifaximin. In this case, increased ammonia production resulted from high protein intake and muscle breakdown, while reduced elimination was due to secondary urea cycle impairment caused by post-surgery undernutrition. Clinicians should consider screening for hyperammonaemia in critically ill patients with new-onset encephalopathy, seizures or refractory vomiting despite normal liver function tests."

Journal • CNS Disorders • Epilepsy • Fatigue • Hepatology • Liver Failure • Metabolic Disorders

Optimizing Preoperative Care: Comparing Mechanical Bowel Preparation Alone Versus Combined Oral Antibiotics in Colorectal Cancer Surgery. (PubMed, Indian J Surg Oncol) - "Patients were divided into two groups: group A (n = 33) received MBP alone, while group B (n = 66) received MBP with rifaximin...The combination of MBP and OA significantly reduced SSIs and anastomotic leaks in elective colorectal surgeries compared to MBP alone, without increasing adverse events. These findings support the integration of OA with MBP in preoperative protocols to enhance surgical outcomes and patient safety in colorectal cancer surgeries."

Journal • Colorectal Cancer • Infectious Disease • Oncology • Solid Tumor

Factors influencing and enhancing health-related quality of life in sarcopenia patients with liver cirrhosis: A comprehensive review. (PubMed, J Family Med Prim Care) - "On the other hand, interventions such as increased physical activity, liver transplantation, stem cell therapy, mindfulness practices, and the use of probiotics, rifaximin, and lactulose showed positive effects on HRQoL. These insights underscore the importance of adopting a comprehensive management approach for liver cirrhosis that addresses not only physical health but also psychological and social well-being. Future research should aim at developing targeted interventions to reduce the burden of these risk factors and promote overall quality of life in this patient population."

HEOR • Journal • Review • CNS Disorders • Depression • Fibrosis • Gastroenterology • Hepatic Encephalopathy • Hepatology • Immunology • Liver Cirrhosis • Mood Disorders • Psychiatry • Sarcopenia • Sleep Disorder • Transplantation

Gut microbiome and its metabolites in liver cirrhosis: mechanisms and clinical implications. (PubMed, Front Cell Infect Microbiol) - "Microbiome-targeted interventions-including lactulose, rifaximin, probiotics or synbiotics, fecal microbiota transplantation, and bile acid modulators-restore community balance in 70-85% of clinical trials, although efficacy and safety vary by etiology and baseline microbiota composition. Integrated microbiome-metabolome models achieve areas under the curve (AUCs) of 0.82-0.90 for noninvasive classification and early detection of cirrhosis. Collectively, these findings underscore reproducible, quantitative microbiome-metabolite alterations and outline a roadmap for microbiome-informed precision care that connects mechanistic insight with clinical application, emphasizing the need for longitudinal and multi-ethnic validation."

Journal • Review • Cardiovascular • CNS Disorders • Fibrosis • Gastroenterology • Hepatic Encephalopathy • Hepatology • Hypertension • Immunology • Inflammation • Liver Cirrhosis • Portal Hypertension • Transplantation

Gut microbiota in irritable bowel syndrome: a narrative review of mechanisms and microbiome-based therapies. (PubMed, Front Immunol) - "Currently, dietary approaches, probiotics, prebiotics, rifaximin, and fecal microbiota transplantation show variable benefit; effects are strain-/context-dependent and evidence certainty varies, with adverse-event reporting inconsistent. This narrative review takes a subtype-aware, mechanism-first perspective to summarize microbiota functions, symptom links, and intervention evidence with safety considerations. This review offers new perspectives and insights for precision treatment and microbiome research in IBS."

Journal • Review • CNS Disorders • Gastrointestinal Disorder • Transplantation

Hyperammonemia and Encephalopathy in Ureterosigmoidostomy: A Nephrology Challenge Beyond the Liver (KIDNEY WEEK 2025) - "He was initiated on Lactulose, rifaximin, bicarbonate and fluid repletion...Broad-spectrum antibiotics with piperacillin-tazobactam and doxycycline were initiated for gut bacterial suppression, resulting in clinical improvement and resolution of HA...Additionally, patients with USS lack a urinary route for NH3 excretion, predisposing them to HA and metabolic encephalopathy. This case highlights the need for awareness of this unique presentation; urinary diversion is necessary"

Bladder Cancer • Chronic Kidney Disease • CNS Disorders • Fibrosis • Genito-urinary Cancer • Hepatology • Immunology • Liver Failure • Metabolic Disorders • Metabolic Dysfunction-Associated Steatohepatitis • Nephrology • Prostate Cancer • Solid Tumor • Urology

Ureaplasma-Induced Hyperammonemia Syndrome - an Acute Complication Post Allogeneic Stem Cell Transplant (ASH 2023) - "During her hospital course, on Day +43, cellulitis of the right arm was diagnosed and treated empirically with amoxicillin-clavulanate on discharge...Empiric antimicrobial coverage with Meropenem and Vancomycin was given, and she was intubated and admitted to the ICU all on the same day...MRI was consistent with hyperammonemic encephalopathy, prompting initiation of intermittent hemodialysis, lactulose, Rifaximin, and L-carnitine...Empirical doxycycline should be considered first line due to the Ureaplasma resistance to other agents such as Azathioprine...Ureaplasma should be considered in immunocompromised patients in the context of fever of unknown origin and altered level of consciousness, especially if rising serum ammonia levels and soft tissue infections is present. The overall 50% mortality associated with the six cases presented demonstrates the significant risk associated with the infection."

Acute Graft versus Host Disease • Acute Lymphocytic Leukemia • Bone Marrow Transplantation • CNS Disorders • Dermatology • Epilepsy • Graft versus Host Disease • Hematological Malignancies • Hepatology • Immunology • Infectious Disease • Leukemia • Lymphoma • Musculoskeletal Pain • Non-Hodgkin’s Lymphoma • Oncology • Pain • Solid Organ Transplantation • Transplantation

Early Initiation of Kidney Replacement Therapy for Hyperammonemia in Acute Liver Failure: A Case Report and Literature Review (KIDNEY WEEK 2025) - "Standard therapy involves protein restriction, sodium correction, and agents such as lactulose and rifaximin. Conclusion This case illustrates the benefit of early RRT in adult ALF with severe hyperammonemia, regardless of kidney function. It emphasizes a proactive approach and highlights the need for standardized guidelines on RRT initiation and cessation in this setting."

Case report • Clinical • Review • Acute Kidney Injury • CNS Disorders • Hepatology • Liver Failure • Metabolic Disorders • Nephrology • Pediatrics • Renal Disease

Diagnostic Puzzle: Concurrent D-Lactic and Renal Tubular Acidosis in Short-Bowel Syndrome (KIDNEY WEEK 2025) - "In that case urine anion gap should be negative, but our patient had a positive urine anion gap (Urine Na 166, urine potassium 21, and urine chloride 71).She was managed with Rifaximin, reduced carbohydrate intake, bicarb, and potassium supplementation...Hyperchloremic non-anion gap metabolic acidosis, hypokalemia, nephrolithiasis, and a positive urine anion gap all point to coexisting distal RTA. The combination of both disorders resulted in a mixed acid-base imbalance, complicating diagnosis and treatment."

Cardiovascular • Fibrosis • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Immunology • Metabolic Disorders • Nephrology • Renal Calculi • Short Bowel Syndrome • Thrombosis

Ammonia Beyond Renal Reach: Fatal Cerebral Edema Despite Renal Replacement Therapy in Decompensated Cirrhosis and Small-Bowel Obstruction (KIDNEY WEEK 2025) - "Introduction Hyperammonemia in decompensated cirrhosis is primarily managed through hepatic metabolism and enteric elimination using agents such as lactulose and rifaximin. This case illustrates the critical need for adjunctive or alternative ammonia-lowering strategies in complex presentations. Clinical Timeline"

Bipolar Disorder • CNS Disorders • Diabetes • Epilepsy • Fibrosis • Gastroenterology • Hepatology • Immunology • Metabolic Disorders • Mood Disorders • Psychiatry

Repurposing rifaximin against Klebsiella pneumoniae via targeting of transcription anti-termination protein RfaH for novel antimicrobial development. (PubMed, Biochem Biophys Res Commun) - "These multifaceted findings collectively investigated the potential of rifaximin as a repurposed antibiotic for the treatment of KP. Finally, a strong interaction of RfaH with rifaximin and subsequent inhibition of the growth of KP provides a novel avenue for antimicrobial development to address the persistent global challenge of antibiotic-resistant infections."

Journal • Infectious Disease • Pneumonia

Comparison of efficacy of rifaximin, probiotics and L-ornithine L-aspartate in overt hepatic encephalopathy: a randomized, phase IV, lactulose controlled clinical trial. (PubMed, Trials) - P4 | "This randomized controlled trial protocol will compare the efficacy of four proposed groups of medications to fill the gap in current knowledge."

Clinical • Clinical protocol • Journal • P4 data • CNS Disorders • Fibrosis • Gastroenterology • Hepatic Encephalopathy • Hepatology • Immunology • Liver Cirrhosis • Movement Disorders

Rifaximin Versus No Intervention for the Treatment of IgA Monoclonal Gammopathy of Undetermined Significance (clinicaltrials.gov) - P2 | N=50 | Recruiting | Sponsor: Fred Hutchinson Cancer Center | Not yet recruiting ➔ Recruiting

Enrollment open • Hematological Malignancies • Monoclonal Gammopathy

Disease Modulating Agents in Cirrhosis. (PubMed, Clin Liver Dis) - "This article evaluates the roles of beta-blockers, albumin, and rifaximin, emphasizing their potential as disease-modulating agents. By exploring these therapeutic strategies within clinical and research frameworks, the article reinforces the necessity for innovative treatments that can fundamentally alter the natural course of cirrhosis and improve patient outcomes."

Journal • Review • Cardiovascular • Fibrosis • Hypertension • Immunology • Portal Hypertension

Efficacy of Rifaximin With NAC in IBS-D (clinicaltrials.gov) - P2 | N=225 | Not yet recruiting | Sponsor: Mark Pimentel, MD | Initiation date: Apr 2025 ➔ Dec 2025

Trial initiation date • Gastrointestinal Disorder

Anti-Inflammatory Drugs for Alcoholic Liver Disease: A Systematic Review on Survival and Adverse Events. (PubMed, Int J Hepatol) - "The interventions compared to corticosteroids included pentoxifylline, anakinra, metadoxine, S-adenosylmethionine (SAMe), granulocyte colony-stimulating factor (G-CSF), rifaximin, and fecal microbiota transplantation (FMT) as monotherapies or combination regimens. The evidence is limited by significant study heterogeneity and a lack of high-quality RCTs. These limitations underscore the critical need for well-powered, rigorous RCTs with standardized survival and safety outcomes."

Adverse events • Journal • Review • Hepatology • Inflammation • Transplantation

Use of Natural language processing to objectively identify hepatic encephalopathy in multiple cohorts. (PubMed, Am J Gastroenterol) - "Five signs, symptoms, and treatment decisions with simple phrases extracted from inpatient charts using NLP define HE across three cohorts. This objectivity could aid future policy on LT priority and HE-event adjudication in clinical trials."

Journal • CNS Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology • Transplantation