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In contrast to other currently available <jats:styled-content style=\"fixed-case\">IBS<\/jats:styled-content> therapies that require daily administration to maintain efficacy, 2\u2010week rifaximin treatment achieved symptom improvement that persisted \u226512\u00a0weeks post\u2010treatment. The mechanisms of action of rifaximin, therefore, may extend beyond direct bactericidal effects. Data suggest that rifaximin may decrease host proinflammatory responses to bacterial products in patients with <jats:styled-content style=\"fixed-case\">IBS<\/jats:styled-content>. In some cases, small intestinal bacterial overgrowth (<jats:styled-content style=\"fixed-case\">SIBO<\/jats:styled-content>) may play a role in the clinical symptoms of <jats:styled-content style=\"fixed-case\">IBS<\/jats:styled-content>. Because of the high level of solubility of rifaximin in the small intestine, rifaximin may reset microbial diversity in this environment. Consistent with this hypothesis, rifaximin has antibiotic efficacy against isolates derived from patients with <jats:styled-content style=\"fixed-case\">SIBO<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Resetting microbial diversity via rifaximin use may lead to a decrease in bacterial fermentation and a reduction in the clinical symptoms of <jats:styled-content style=\"fixed-case\">IBS<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.13437","type":"journal-article","created":{"date-parts":[[2015,11,30]],"date-time":"2015-11-30T17:21:02Z","timestamp":1448904062000},"page":"37-49","source":"Crossref","is-referenced-by-count":67,"title":["Review article: potential mechanisms of action of rifaximin in the management of irritable bowel syndrome with diarrhoea"],"prefix":"10.1111","volume":"43","author":[{"given":"M.","family":"Pimentel","sequence":"first","affiliation":[{"name":"GI Motility Program Cedars\u2010Sinai Medical Center Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,11,30]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2296-14-92"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2014.187"},{"key":"e_1_2_7_4_1","first-page":"495","article-title":"Prevalence of irritable bowel syndrome: a community survey","volume":"54","author":"Wilson S","year":"2004","journal-title":"Br J Gen Pract"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0269-2813.2004.01807.x"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmn087"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-200624010-00002"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.giec.2008.12.004"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2006.108712"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2007.04.005"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-145-8-200610170-00004"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2006.00458.x"},{"key":"e_1_2_7_13_1","first-page":"89","article-title":"Small intestine bacterial overgrowth in irritable bowel syndrome: a retrospective study with rifaximin","volume":"52","author":"Cuoco L","year":"2006","journal-title":"Minerva Gastroenterol Dietol"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1004409"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12087"},{"key":"e_1_2_7_16_1","first-page":"1314","article-title":"Rifaximin treatment for small intestinal bacterial overgrowth in children with irritable bowel syndrome","volume":"17","author":"Scarpellini E","year":"2013","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2011.355"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2004.05.019"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00161-10"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.2165\/10898630-000000000-00000"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1159\/000081990"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.44.8.2205-2206.2000"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2013.12.008"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1179\/joc.2008.20.2.186"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1586\/14787210.3.2.201"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1159\/000081991"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(08)62544-5"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0907893"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-014-3157-8"},{"key":"e_1_2_7_30_1","unstructured":"PylerisE Giamarellos\u2010BourboulisEJ PistikiA BarbatzasC KimG PimentelM.Intestinal overgrowth in irritable bowel syndrome. 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