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Comparative Study of Rifaximin and Ciprofloxacin-Metronidazole in Diabetic Patients with Small Intestine Bacterial Overgrowth
Dr. Asma Qibtia
post-graduate resident, Internal Medicine, Allied Hospital I, Faisalabad.
Dr. Ghulam Abbas Tahir
Assistant Professor (Medicine), Allied Hospital I, Faisalabad.
Dr. Muhammad Owais Fazal
Associate Professor (Medicine), Allied Hospital I, Faisalabad.
Dr. Uneeba Syed
Assistant professor of endocrinology, Endocrine department, Allama Iqbal medical college / Jinnah hospital lahore
Dr. Zainab Asim
Post-Graduate Resident, Allied Hospital I, Faisalabad.
Dr. Aqsa Sadaf
Postgraduate resident, Internal Medicine, Allied Hospital I, Faisalabad.
Dr. Syed Kamal Husnain Shah
Senior Registrar (Medicine), Fellow Rheumatology, Madinah Teaching Hospital, Faisalabad.
Keywords:
COPD, Budesonide/Glycopyrronium/Formoterol Fumarate, Budesonide and Tiotropium Dihydrate, Multicenter Study, Therapeutic Efficacy, Lung Function, Symptoms, Quality of Life.
Abstract
Aim: This study aimed to evaluate the effectiveness and safety of rifaximin compared to ciprofloxacin combined with metronidazole in the treatment of small intestinal bacterial overgrowth (SIBO), with or without symptoms, among diabetic patients.
Objective: The primary objectives were to assess and compare the improvement in gastrointestinal symptoms following treatment with rifaximin versus ciprofloxacin-metronidazole, and to quantify bacterial load reduction using diagnostic upper gastrointestinal (UGI) endoscopy for jejunal aspiration and culture. Secondary objectives included evaluating the safety profiles of both regimens in diabetic individuals.
Study Design: Randomized controlled trial
Setting: Outpatient Department of Medicine, Allied Hospital I, Faisalabad
Duration: 6 Months
Materials and Methodology: A total of 200 diabetic patients diagnosed with SIBO were enrolled and randomly assigned to receive either rifaximin (550 mg three times daily) or a combination of ciprofloxacin (500 mg twice daily) with metronidazole (500 mg three times daily) for 14 days. Baseline data included demographic characteristics, type and duration of diabetes, and symptom severity scores. The primary outcomes measured were improvement in gastrointestinal symptoms and reduction in bacterial load based on validated symptom questionnaires and jejunal aspirate culture obtained via diagnostic UGI endoscopy. Secondary endpoints included adverse effects and changes in health-related quality of life. Data analysis was performed using SPSS, applying t-tests, chi-square tests, and multivariate regression as appropriate.
Results: Both treatment groups showed notable improvement in gastrointestinal symptoms and fecal bacterial flora. The rifaximin group demonstrated a 53% reduction in symptom scores compared to a 47% reduction in the ciprofloxacin-metronidazole group. Greater reductions in bacterial counts confirmed by jejunal aspirate cultures were observed with rifaximin (P < 0.001). Adverse events were less frequent in the rifaximin group (10%) compared to the ciprofloxacin-metronidazole group (25%), with the latter experiencing more significant gastrointestinal side effects. Overall, rifaximin was associated with better treatment adherence and higher clinical efficacy.
Conclusion: Rifaximin is a more effective and better-tolerated treatment option for diabetic patients with SIBO than the combination of ciprofloxacin and metronidazole. These findings support its role as a preferred first-line therapy in this population, potentially improving both symptom control and quality of life.
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Published
2026-07-20
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