Efficacy of Rifaximin in patients with Irritable Bowel Syndrome and its comparison with previously used drugs : a retrospective and prospective study. OMKAR SINGH Sachin Srivastav, Ashish Gautam, Mridul Chaturvedi, Dept of Medicine, S.N Medical College, Agra

AIMS AND OBJECTIVE- To evaluate the efficacy of Rifaximin at definite set points after therapy in patients with Irritable Bowel Syndrome (IBS) - Diarrhea predominant and its comparison with other commonly prescribed drugs. Study include those patients who have previously received various treatments including  Loperamide  Flouroquinilone+Metrogyl  Metrogyl  Psyllium Husk  Smooth Muscle Relaxants  Tricyclic Antidepressants  SSRIs  Probiotics  Prebiotics Patients were subjected to a detailed questionnaire regarding their satisfaction with various drugs. Rifaximin was started and their satisfaction level was recorded on 10 th, 40 th, 60 th,75 th,and 90 th day. Those patients who have not received any of the above drugs were prescribed the drug for 10 days and their level of satisfaction was noted

INCLUSION CRITERIA The ROME 3 Criteria for diagnosis of IBS-D, Patients attending the OPD having complaints suggestive of IBS-D and did not respond with oral anti amoebic and gut specific antibiotics, Patients previously labeled IBS- D after essential investigations and did not respond with previous treatment Between 20 to 50 years of age were included in the study. EXCLUSION CRITERIA Patient of IBS-C, IBS-M and IBS-U subtype Those who were taking Theophylline ATT, Narcotics, Alosetron, Lubiprostone, Warfarin,antipsychotics,antispasmodic, Antidiarrheal, Probiotics Any patient taking gut specific antibiotic or rifaximin patients With underlying co morbid conditions that can alter study results like diabetes mellitus, thyroid dysfunction, HIV, chronic kidney disease, chronic liver disease, abdominal tuberculosis and previous bowel resection or abdominal surgery (except cholecystectomy, appendectomy and pelvic organ surgery or cesarean section). Patients were subjected to a detailed questionnaire regarding their satisfaction with various drugs. Rifaximin was started and their satisfaction level was recorded on 10 th, 40 th, 60 th,75 th,and 90 th day. Total number of patients were 57 were inclluded in the study based on inclusion and exclusion criteria

Drugs Average satisfaction Rifaximin2.89 Loperamide2.24 Psyllium husk2.03 Smooth muscle relaxant 1.93 Tricyclic antidepressant 2 Ssris1.26 Probiotics1.57 Fq+metrogyl2.70 Metrogyl2.63 Prebiotics2.12. STUDY DAYS AVERAGE SATISFACTION with RIFAXIMIN

CONCLUSION Rifaximin----very effective drug for IBS in doveloped countries where recurrent infections are rare. However in developing countries like India where frequency of repeated infections due to poor hygenic conditions is high its efficacy is questioned We studied Rifaximin, one of the latest drug for the management of this disorder and compared it with drugs previously used. This study, a combination of retrospective as well as prospective showed that Rifaximin has the most satisfactory results in these patients and the average satisfaction level was also highest for Rifaximin, however the results were not sustained as with other drugs However further a second phase study is required to assess the effect of Rifaximin on repeating the therapy again and how frequently it should be repeated with a larger sample size. RIFAXIMIN EFFICACY BEST AMONG ALL DRUGS HOWEVER EFFECT NOT SUSTAINED MOST LIKELY DUE TO REPEATED INFECTION.