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BMJ 2011; 342 doi: (Published 11 January 2011) Cite this as: BMJ 2011;342:d92

Antibiotics for irritable bowel syndrome?

Rifaximin is a poorly absorbed antibiotic that targets a wide range of gut flora. The manufacturers are currently evaluating rifaximin as a treatment for irritable bowel syndrome, and twin placebo controlled trials in patients without constipation suggest it can work. Adults who took rifaximin for two weeks were more likely to report adequate relief of symptoms than controls (40.7% (254/624) v 31.7% (201/634); P<0.001, both studies combined). They were also more likely to report relief from bloating (40.2% (251/624) v 30.3% (192/634); P<0.001). The benefits were modest but persisted for 10 weeks after the end of treatment. Symptoms were beginning to return in both groups after three months.

An editorial cautiously welcomes these results (p 81). Irritable bowel syndrome is common and few effective therapeutic options exist. Rifaximin looked safe in these trials, and the drug already has a good track record in the prevention and treatment of traveller’s diarrhoea. It is possible, even probable, that an antibiotic such as rifaximin can help some people with irritable bowel syndrome, but we need to find out exactly who would benefit. Treating everyone would be a mistake at this stage, because widespread use of a poorly absorbed antibiotic could have unintended consequences on bacterial resistance, particularly if patients need serial treatments to maintain the response.

18th century giant has contemporary relatives and an ancient ancestor

The skeleton of one of the best known giants in medical literature is housed in the Hunterian Museum in London. He was born in Northern Ireland in 1761 and died just 22 years later from the complications of his gigantism. He was 231 cm tall—about 7 feet and 7 inches. After genotyping material from two of his teeth, researchers now believe this celebrated giant was related to a cluster of contemporary Northern Irish families with a predisposition to pituitary adenomas. They all share …

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