The recent publication of "Drug Therapy: Rifaximin" by Bajaj and Riggio1 offers interesting observations by colleagues. They voice concern that continuous rifaximin administration "could have the potential to increase resistance to rifaximin," but they cite no objective clinical data in support of their hypothesis. They also cite the two cases of Clostridium difficile in the rifaximin group reported in the registration study of rifaximin for the treatment of hepatic encephalopathy by Bass and colleagues,2 and they advise vigilance against C. difficile in patients with cirrhosis treated with rifaximin. At the US Food and Drug Administration meeting in March 2010, this matter was extensively studied and discussed. Both patients who developed C. difficile had concurrently received other antimicrobials known to cause C. difficile infection. Bajaj and Riggio's suggestion of pulse therapy with rifaximin (to reduce costs) is without precedent or merit in the realm of antimicrobial therapy.
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