Rifaximin does not increase the rate of 30-day mortality in patients with cirrhosis and daptomycin in two National US-based cohorts

Abstract Recently, a higher rate of resistance to daptomycin in patients exposed to rifaximin has been shown. However, since laboratory resistance patterns found in silico or ex vivo do not account for the complex pharmacokinetic, pharmacodynamic, microbial, and host-related factors in patients, the clinical impact of rifaximin on resistance to daptomycin needs clarification. Although rifaximin is commonly used for irritable bowel syndrome and traveler’s diarrhea, the main reason for long-term use is hepatic encephalopathy (HE) in cirrhosis. Here we show that 30-day outcomes (transplant or mortality) in two large US-based cohorts (Veterans Affairs Corporate Data Warehouse and TriNetX database) in daptomycin users on rifaximin were not different compared to those without daptomycin. with or without pre-existing rifaximin use.