Abstract
Aims
Enteric bacteria are thought to contribute to the pathogenesis of Crohn’s disease, and antibiotics may be an effective therapy. This study examines the efficacy of the nonsystemic (<0.4% absorbed) antibiotic rifaximin for inducing remission in patients with Crohn’s disease.
Methods
Data from charts of patients with Crohn’s disease who received rifaximin between 2001 and 2005 and had a Crohn’s disease activity index score ≥220 at the time of rifaximin initiation were analyzed. The use of concomitant medications (e.g., steroids, anti-inflammatory agents) was allowed.
Results
In the 68 patient charts analyzed, the median duration of rifaximin treatment was 16.6 weeks, and the majority of patients (94%) received rifaximin 600 mg/day. Eighteen patients (26%) received rifaximin monotherapy, and 31 patients (46%) received concomitant steroids. The median baseline Crohn’s disease activity index score at the time of rifaximin initiation was 265 (range, 220–460), and the mean duration of Crohn’s disease was 17 years (range, 1–50 years). Crohn’s disease remission occurred in 65% of patients. A 70% remission rate was achieved in patients who did not receive steroids, versus 58% in patients who received steroids. Clinical improvements continued 4 months after rifaximin initiation. Remission was achieved in 67% of patients who received rifaximin monotherapy.
Conclusions
Rifaximin therapy was associated with clinical improvement in patients with Crohn’s disease and may be a useful treatment option to consider for inducing and maintaining remission.
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References
Cameron JL, Hamilton SR, Coleman J, Sitzmann JV, Bayless TM. Patterns of ileal recurrence in Crohn’s disease. A prospective randomized study. Ann Surg. 1992;215:546–551. (discussion 551–542).
Podolsky DK. Inflammatory bowel disease. N Engl J Med. 2002;347:417–429.
Rutgeerts P, Goboes K, Peeters M, et al. Effect of faecal stream diversion on recurrence of Crohn’s disease in the neoterminal ileum. Lancet. 1991;338:771–774.
Sartor RB. Mechanisms of disease: pathogenesis of Crohn’s disease and ulcerative colitis. Nat Clin Pract Gastroenterol Hepatol. 2006;3:390–407.
Marks DJ, Segal AW. Innate immunity in inflammatory bowel disease: a disease hypothesis. J Pathol. 2008;214:260–266.
Mow WS, Vasiliauskas EA, Lin YC, et al. Association of antibody responses to microbial antigens and complications of small bowel Crohn’s disease. Gastroenterology. 2004;126:414–424.
Ambrose NS, Allan RN, Keighley MR, et al. Antibiotic therapy for treatment in relapse of intestinal Crohn’s disease. A prospective randomized study. Dis Colon Rectum. 1985;28:81–85.
Arnold GL, Beaves MR, Pryjdun VO, Mook WJ. Preliminary study of ciprofloxacin in active Crohn’s disease. Inflamm Bowel Dis. 2002;8:10–15.
Blichfeldt P, Blomhoff JP, Myhre E, Gjone E. Metronidazole in Crohn’s disease. A double blind cross-over clinical trial. Scand J Gastroenterol. 1978;13:123–127.
Colombel J-F, Lemann M, Cassagnou M, et al. A controlled trial comparing ciprofloxacin with mesalazine for the treatment of active Crohn’s disease. Am J Gastroenterol. 1999;94:674–678.
Leiper K, Morris AI, Rhodes JM. Open label trial of oral clarithromycin in active Crohn’s disease. Aliment Pharmacol Ther. 2000;14:801–806.
Prantera C, Zannoni F, Scribano ML, et al. An antibiotic regimen for the treatment of active Crohn’s disease: a randomized, controlled clinical trial of metronidazole plus ciprofloxacin. Am J Gastroenterol. 1996;91:328–332.
Steinhart AH, Feagan BG, Wong CJ, et al. Combined budesonide and antibiotic therapy for active Crohn’s disease: a randomized controlled trial. Gastroenterology. 2002;123:33–40.
Sutherland L, Singleton J, Sessions J, et al. Double blind, placebo-controlled trial of metronidazole in Crohn’s disease. Gut. 1991;32:1071–1075.
Ursing B, Alm T, Barany F, et al. A comparative study of metronidazole and sulfasalazine for active Crohn’s disease: the cooperative Crohn’s disease study in Sweden. II. Result. Gastroenterology. 1982;83:550–562.
Buning C, Lochs H. Conventional therapy for Crohn’s disease. World J Gastroenterol. 2006;12:4794–4806.
Jiang Z-D, Ke S, Palazzini E, Riopel L, DuPont HL. In vitro activity and fecal concentration of rifaximin after oral administration. Antimicrob Agents Chemother. 2000;44:2205–2206.
DuPont HL, Jiang Z-D, Okhuysen PC, et al. A randomized, double-blind, placebo-controlled trial of rifaximin to prevent travelers’ diarrhea. Ann Intern Med. 2005;142:805–812.
Steffen R, Sack DA, Riopel L, et al. Therapy of travelers’ diarrhea with rifaximin on various continents. Am J Gastroenterol. 2003;98:1073–1078.
Jiang ZD, DuPont HL. Rifaximin: in vitro and in vivo antibacterial activity—a review. Chemotherapy. 2005;51(suppl 1):67–72.
Fiorucci S, Distrutti E, Mencarelli A, Barbanti M, Palazzini E, Morelli A. Inhibition of intestinal bacterial translocation with rifaximin modulates lamina propria monocytic cells reactivity and protects against inflammation in a rodent model of colitis. Digestion. 2002;66:246–256.
Best WR, Becktel JM, Singleton JW, Kern FJ. Development of a Crohn’s disease activity index: National Cooperative Crohn’s Disease Study. Gastroenterology. 1976;70:439–444.
Shafran I, Johnson LK. An open-label evaluation of rifaximin in the treatment of active Crohn’s disease. Curr Med Res Opin. 2005;21:1165–1169.
Prantera C, Lochs H, Campieri M, et al. Antibiotic treatment of Crohn’s disease: results of a multicentre, double blind, randomized, placebo-controlled trial with rifaximin. Aliment Pharmacol Ther. 2006;23:1117–1125.
Gionchetti P, Rizzello F, Lammers KM, et al. Antibiotics and probiotics in treatment of inflammatory bowel disease. World J Gastroenterol. 2006;12:3306–3313.
Aberra FN, Brensinger CM, Bilker WB, Lichtenstein GR, Lewis JD. Antibiotic use and the risk of flare of inflammatory bowel disease. Clin Gastroenterol Hepatol. 2005;3:459–465.
Rutgeerts P, Hiele M, Geboes K, et al. Controlled trial of metronidazole treatment for prevention of Crohn’s recurrence after ileal resection. Gastroenterology. 1995;108:1617–1621.
Rutgeerts P, Van Assche G, Vermeire S, et al. Ornidazole for prophylaxis of postoperative Crohn’s disease recurrence: a randomized, double-blind, placebo-controlled trial. Gastroenterology. 2005;128:856–861.
Shafran I, Burgunder P. Rifaximin for the treatment of newly diagnosed Crohn’s disease: a case series. Am J Gastroenterol. 2008;103:2158–2160.
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Editorial assistance was provided under the direction of the authors by MedThink Communications with support from Salix Pharmaceuticals, Inc.
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Shafran, I., Burgunder, P. Adjunctive Antibiotic Therapy with Rifaximin May Help Reduce Crohn’s Disease Activity. Dig Dis Sci 55, 1079–1084 (2010). https://doi.org/10.1007/s10620-009-1111-y
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DOI: https://doi.org/10.1007/s10620-009-1111-y