Xifaxan vs. Rifampin for Diarrhea and Skin Infection: Important Differences and Potential Risks.

Key takeaways

Xifaxan (rifaximin) and Rifadin (rifampin) are both rifamycin antibiotics, but they are used to treat different conditions. Xifaxan is taken orally and is used to treat travelers' diarrhea caused by *E. coli*, irritable bowel syndrome with diarrhea (IBS-D), and to prevent hepatic encephalopathy (HE) in adults. On the other hand, Rifadin is used to treat active and latent tuberculosis (TB) and to prevent the spread of meningococcal infections in carriers. Rifadin is available as an oral tablet or intravenous (IV) injection and is often used in combination with other TB medications. Xifaxan is typically taken 2 to 3 times a day, while Rifadin is usually taken once or twice daily. Rifadin can cause a temporary change in the color of your body fluids and teeth, which is not a side effect of Xifaxan. Additionally, Rifadin has a generic form available, making it a lower-cost option. Both medications require careful adherence to dosing schedules to avoid resistance and ensure effectiveness.

Xifaxan

(rifaximin)

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Rifampin

(Rifadin)

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Summary for Xifaxan

Prescription only

Xifaxan (rifaximin) is a rifamycin antibiotic. It's used to treat people 12 years and older with travelers' diarrhea caused by Escherichia coli (E. coli). It can also treat irritable bowel syndrome with diarrhea (IBS-D) in adults. In addition, this medication can help prevent hepatic encephalopathy (HE) in adults. Xifaxan (rifaximin) is a tablet that's taken by mouth a few times per day. Side effects generally include swelling, dizziness, and fatigue.

Indications for Xifaxan

Treatment of travelers' diarrhea caused by E. coli in people ages 12 years and older
Treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults
Prevention of hepatic encephalopathy (HE) in adults

Pros and Cons for Xifaxan

Pros

Can treat travelers' diarrhea in children 12 years and older
A recommended option for adults with IBS-D
Can help prevent repeat episodes of hepatic encephalopathy (brain damage in adults with advanced liver problems)

Cons

Need to take 2 or 3 times per day, depending on your condition
Doesn't treat travelers' diarrhea caused by other germs besides E. coli
Only available as tablets

Common Side Effects for Xifaxan

Travelers' diarrhea:

Headache (10%)

IBS-D:

Nausea (2-3%)

HE:

Swelling in the hands, ankles, or feet (15%)
Nausea (14%)
Dizziness (13%)
Tiredness (12%)
Fluid buildup in the stomach and swelling of the stomach (11%)

Warnings for Xifaxan

Doesn't work well for travelers' diarrhea caused by other germs besides E. coli
Diarrhea from Clostridioides difficile infection
Caution use in people with severe liver problems
Caution use with certain medications

Summary for Rifampin

Prescription only

Rifampin (Rifadin) is an antibiotic used to treat active and latent tuberculosis (TB). It also helps prevent the spread of meningococcal infections by people who carriers of the bacteria, but aren't showing symptoms. Rifampin (Rifadin) is taken by mouth once or twice daily, depending on your medical conditions. If you're taking it for TB, your provider might prescribe other medications as well, like isoniazid. One side effect of rifampin (Rifadin) is that it can temporarily change the color of your teeth, body fluids, and even urine as a side effect.

Indications for Rifampin

Tuberculosis (TB)
Meningococcal carriers (when there's bacteria living in the nose and/or throat, but not causing infection)

Pros and Cons for Rifampin

Pros

One of the first-choice antibiotics for treating TB
Taken once daily for TB treatment
For people who carry the meningococcal bacteria, taking rifampin (Rifadin) for just 2 days helps prevent the spread of infection
Can be made into an oral suspension if you or your child has a hard time swallowing capsules
Available in an injectable form if you're in the hospital and can't take medications by mouth
Available as a lower-cost generic

Cons

Must be used in combination with other anti-TB antibiotics when treating active TB
Can change the color of your teeth and body fluids and stain your contact lenses
Skipping doses can quickly cause drug resistance, making it much harder to treat the infection.
Can cause liver injury, so it's recommended to avoid alcohol
Interacts with many medications, and can lower the medication levels in the body
Not recommended for the treatment of serious meningococcal infections