Open AccessDouble‐blind, Placebo‐controlled Antibiotic Treatment Study of Small Intestinal Bacterial Overgrowth in Children With Chronic Abdominal Pain
Author(s) -
Collins Brynie Slome,
Lin Henry C
Publication year - 2011
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0b013e3181effa3b
Subject(s) - rifaximin , medicine , lactulose , placebo , small intestinal bacterial overgrowth , irritable bowel syndrome , gastroenterology , abdominal pain , breath test , antibiotics , pathology , helicobacter pylori , alternative medicine , microbiology and biotechnology , biology
Background and Objectives: Chronic abdominal pain (CAP) in children may be a precursor to irritable bowel syndrome (IBS) in adults. The prevalence of abnormal lactulose breath tests (LBT) suggesting small intestinal bacterial overgrowth (SIBO) has been reported as 91% in children with CAP and 35% in healthy controls. In addition, patients with IBS with SIBO who responded to nonabsorbable antibiotic treatment with normalization of LBT reported 75% global improvement in symptoms. The aim of the study was to test whether treatment with a nonabsorbable antibiotic may reduce symptoms in children with CAP. Methods: Seventy‐five children ages 8 to 18 years with CAP based on Rome II criteria were enrolled. Subjects underwent baseline LBT and completed symptom‐based questionnaires. They were then randomized in a 2:1, double‐blind fashion to receive a 10‐day course of 550 mg of rifaximin or placebo 3 times per day (t.i.d.). LBT and questionnaires were repeated 2 weeks after treatment. Results: Forty‐nine children received rifaximin and 26 received placebo. There were no differences in demographics between groups. Ninety‐four percent who received rifaximin and 92% who received placebo had abnormal baseline LBT, suggesting SIBO (not significant [NS]). There was no significant difference in symptom improvement between groups; however, only 20% of children treated with rifaximin achieved a normalized repeat LBT, demonstrating successful treatment of SIBO. Conclusions: Similar to adults with IBS, the prevalence of abnormal LBT suggesting SIBO in children with CAP is high; however, treatment with 10 days of rifaximin has low efficacy in normalizing LBT in this group. Additional studies are needed to determine whether a treatment approach with higher efficacy would lead to improvement in children with CAP.