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Rifaximin + misoprostol is a combination therapy being investigated by the Chinese University of Hong Kong for the treatment of small bowel ulcers in aspirin users with small bowel bleeding. Rifaximin is a non-absorbed, macrocyclic antibiotic that inhibits bacterial RNA synthesis by binding to the beta-subunit of bacterial DNA-dependent RNA polymerase. Misoprostol is a synthetic prostaglandin E1 analog that exhibits cytoprotective effects by increasing mucus and bicarbonate secretion and inhibiting gastric acid production. This combination therapy is hypothesized to be more effective than misoprostol alone by targeting the bacterial flora that may contribute to the pathogenesis of aspirin-induced small bowel injury. The treatment is typically administered orally, with clinical trials evaluating its efficacy in promoting mucosal healing in the small intestine.
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