Evidence map›Paper›PMID 39103611›Full record

ArticleScientific reports2024

Low dose rifaximin combined with N-acetylcysteine is superior to rifaximin alone in a rat model of IBS-D: a randomized trial.

Gabriela Leite, Ali Rezaie, Walter Morales, Stacy Weitsman, Juliana de Freitas Germano, Gillian M Barlow, Gonzalo Parodi, Maya L Pimentel, Maria Jesus Villanueva-Millan, Maritza Sanchez and 3 more

Abstract read
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In one paragraph

Article in Scientific reports, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Review
  2. Article
  3. Modern concepts of small intestinal bacterial overgrowth.Current opinion in gastroenterology · 2025
    Review
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Gabriela LeiteMedically Associated Science and Technology Program, Cedars-Sinai, Los Angeles, CA, USA.
Ali RezaieMedically Associated Science and Technology Program, Cedars-Sinai, Los Angeles, CA, USA.
Walter MoralesMedically Associated Science and Technology Program, Cedars-Sinai, Los Angeles, CA, USA.
Stacy WeitsmanMedically Associated Science and Technology Program, Cedars-Sinai, Los Angeles, CA, USA.
Juliana de Freitas GermanoMedically Associated Science and Technology Program, Cedars-Sinai, Los Angeles, CA, USA.
Gillian M BarlowMedically Associated Science and Technology Program, Cedars-Sinai, Los Angeles, CA, USA.
Gonzalo ParodiMedically Associated Science and Technology Program, Cedars-Sinai, Los Angeles, CA, USA.
Maya L PimentelMedically Associated Science and Technology Program, Cedars-Sinai, Los Angeles, CA, USA.
Maria Jesus Villanueva-MillanMedically Associated Science and Technology Program, Cedars-Sinai, Los Angeles, CA, USA.
Maritza SanchezMedically Associated Science and Technology Program, Cedars-Sinai, Los Angeles, CA, USA.
Sarah AyyadMedically Associated Science and Technology Program, Cedars-Sinai, Los Angeles, CA, USA.
Ruchi MathurMedically Associated Science and Technology Program, Cedars-Sinai, Los Angeles, CA, USA.
Mark PimentelMedically Associated Science and Technology Program, Cedars-Sinai, Los Angeles, CA, USA. mark.pimentel@cshs.org.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Rifaximin is FDA-approved for treatment of irritable bowel syndrome with diarrhea (IBS-D), but poor solubility may limit its efficacy against microbes in the mucus layer, e.g. Escherichia coli. Here we evaluate adding the mucolytic N-acetylcysteine (NAC) to improve rifaximin efficacy. In a resazurin checkerboard assay, combining rifaximin with NAC had significant synergistic effects in reducing E. coli levels. The optimal rifaximin + NAC combination was then tested in a validated rat model of IBS-D (induced by cytolethal distending toxin [CdtB] inoculation). Rats were inoculated with vehicle and treated with placebo (Control-PBS) or rifaximin + NAC (Control-Rif + NAC, safety), or inoculated with CdtB and treated with placebo (CdtB-PBS), rifaximin (CdtB-Rifaximin), or rifaximin + NAC (CdtB-Rif + NAC) for 10 days. CdtB-inoculated rats (CdtB-PBS) developed wide variability in stool consistency (P = 0.0014) vs. controls (Control-PBS). Stool variability normalized in rats treated with rifaximin + NAC (CdtB-Rif + NAC) but not rifaximin alone (CdtB-Rifaximin). Small bowel bacterial levels were elevated in CdtB-PBS rats but normalized in CdtB-Rif + NAC but not CdtB-Rifaximin rats. E. coli and Desulfovibrio spp levels (each associated with different IBS-D microtypes) were also elevated in CdtB-inoculated (CdtB-PBS) but normalized in CdtB-Rif + NAC rats. Cytokine levels normalized only in CdtB-Rif + NAC rats, in a manner predicted to be associated with reduced diarrhea driven by reduced E. coli. These findings suggest that combining rifaximin with NAC may improve the percentage of IBS-D patients responding to treatment.

Indexed as

AcetylcysteineDiarrheaDisease Models, AnimalEscherichia coliIrritable Bowel SyndromeRifaximinAnimalsDrug Therapy, CombinationMaleRatsRats, Sprague-DawleyAcetylcysteineRifaximinBacterial overgrowthDesulfovibrioDiarrhea-predominantEscherichia coliIrritable bowel syndromeN-acetylcysteineRat modelRifaximin

Identifiers

PMID39103611
PMCPMC11300865

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.