Antibiotic resistance in patients with cirrhosis continues to draw significant attention. With a propensity to frequent hospitalisations, cirrhotics are subject to frequent antibiotic prescription. This increases their risk of developing resistance to one or more antimicrobial agents, making management of their condition particularly challenging. Despite advancements being made in the management of liver disease, mortality rates continue to rise; almost fivefold in those under 65 years, whilst remaining the leading cause of death in those between the ages of 35-49 years. Urgent alternative therapeutic options to prevent disease progression and cirrhosis-associated complications are urgently required. Rifaximin is one such example, with its use in patients with cirrhosis demonstrating additional benefits beyond its current licensed use. Its current licensed use in the UK is for the prevention of hepatic encephalopathy and traveller’s diarrhoea; however, its use in the context of enteric-driven pathologies has been explored. Through rifaximin’s key central action as a broad-spectrum antimicrobial, it has the ability to modulate the gut-liver axis via removal of gut microbial products associated with the progression of cirrhosis and its sequalae.
The benefits of rifaximin use continues to gather some momentum, given its non-absorbable nature and well tolerated side-effect profile, and these require consideration. With broad spectrum antimicrobial properties, its use may assist in overcoming the conundrum posed of antibiotic resistance amongst cirrhotics.
This literature review discusses the chemical and antimicrobial properties of rifaximin, its licenced indication for use, and its reported benefits beyond this. We also consider concerns regarding rifaximin resistance.