European Journal of Biomedical and Pharmaceutical Sciences

THE EFFECT OF RIFAXIMIN AND NEOMYCIN ALONE, AND IN COMBINATION FOR THE SYMPTOMS OF SMALL INTESTINAL BACTERIAL OVERGROWTH-IRRITABLE BOWEL SYNDROME: A PATHOPHYSIOLOGY APPROACH

*Adinarayana Reddy P., Dr. J. N. Suresh Kumar, Nikhileshwar R., Abhinaya V.V.S, Ramya D., Pavan Kumar V.

ABSTRACT

Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder characterized by abdominal pain and  altered bowel habits, affecting approximately 11% of the global population. The condition can manifest in various forms, including IBS with diarrhea (IBS-D), IBS with constipation (IBS-C), mixed bowel habits (IBS-M), and unclassified symptoms (IBS-U). Recent studies have implicated small intestinal bacterial overgrowth (SIBO) as a potential contributing factor to IBS, suggesting that dysbiosis in the gut microbiome may exacerbate symptoms. This review examines the therapeutic roles of antibiotics, specifically rifaximin and neomycin, in managing IBS symptoms associated with SIBO. Rifaximin, a non-absorbable broad-spectrum antibiotic, has shown significant efficacy in alleviating IBS symptoms by acting locally in the gut and reducing mucosal inflammation. Clinical trials indicate that rifaximin treatment results in a notable improvement in global symptom relief compared to placebo. Neomycin, while effective against specific bacterial strains, presents challenges due to its potential side effects and limited normalization rates in breath tests for SIBO. Combining rifaximin and neomycin may enhance treatment outcomes by leveraging the strengths of both antibiotics. Studies indicate that this combination therapy not only improves clinical symptoms more effectively than monotherapy but also leads to higher rates of SIBO eradication. Furthermore, a deeper understanding of the pathophysiological mechanisms underlying IBS—particularly the interactions within the brain-gut axis, genetic predispositions, and gut microbiota—can inform more targeted and effective treatment strategies. This review underscores the importance of recognizing the multifactorial nature of IBS and the need for tailored therapeutic approaches that consider both microbial imbalances and individual patient experiences. Future research should focus on optimizing antibiotic regimens and exploring additional therapeutic modalities to enhance patient outcomes in IBS management.

Keywords: IBS, SIBO, Rifaximin, Neomycin, Combination Antibiotics.