Commentary: towards an effective and safe treatment of small intestine bacterial overgrowth – authors' reply
Year: 2013
Type: editorial
Abstract: We appreciate the thoughtful commentary provided by Drs Scarpignato and Gatta1 regarding our article.2 As rifaximin (the most frequently studied antibiotic) has been available for use in Italy for many years, we greatly value their perspective. Drs Scarpignato and Gatta highlight issues related to the studies included in our meta-analysis, particularly the two negative trials of rifaximin vs. placebo.3, 4 Although our meta-analysis of rifaximin vs. placebo did not show a statistically significant benefit for rifaximin, this was probably due to the small number of studies. Drs Scarpignato and Gatta note an additional trial that we had excluded from our study due to incomplete outcome reporting.5 Based on their communication with the authors of that study, 28 of 32 subjects receiving rifaximin had breath test normalisation compared to 0 of 20 placebo-treated subjects. We therefore repeated our meta-analysis of rifaximin vs. placebo including these data. The effectiveness ratio for rifaximin increased (from 1.97 to 2.79), but the results still did not quite reach statistical significance (95% confidence interval 0.79, 9.92, P = 0.11). In their commentary, Drs Scarpignato and Gatta report their own proportion meta-analysis, which includes not only clinical trials but also case series.6 Their pooled eradication rate for rifaximin was 68%, somewhat higher than our pooled eradication rate of 49.5%. This probably reflects both publication bias inherent in case series and the relatively small number of trials including rifaximin monotherapy (n = 8) and enrolled subjects (n = 325) meeting inclusion criteria for our study. The results of their proportion meta-analysis are complementary to our work; taken together, these works provide an expanded perspective on antibiotic therapy for small intestinal bacterial overgrowth (SIBO). We are in agreement that poorly absorbed antibiotics such as rifaximin represent an attractive treatment strategy for SIBO eradication. Identifying which patients to treat, which antibiotics to use and ideal antibiotic dosing are challenges that should be further addressed in our efforts to effectively treat SIBO. The authors' declarations of personal and financial interests are unchanged from those in the original article.2
DOI: 10.1111/apt.12533
Authors: J. L. Sewell, M. Somsouk, S. C. Shah, L. W. Day
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2111378312