Digestive Diseases and Sciences

, Volume 55, Issue 4, pp 1079–1084 | Cite as

Adjunctive Antibiotic Therapy with Rifaximin May Help Reduce Crohn’s Disease Activity




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.


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.


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.


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.


Inflammatory bowel disease Crohn’s disease Nonsystemic antibiotic Rifaximin Crohn’s disease activity index 


  1. 1.
    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).CrossRefPubMedGoogle Scholar
  2. 2.
    Podolsky DK. Inflammatory bowel disease. N Engl J Med. 2002;347:417–429.CrossRefPubMedGoogle Scholar
  3. 3.
    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.CrossRefPubMedGoogle Scholar
  4. 4.
    Sartor RB. Mechanisms of disease: pathogenesis of Crohn’s disease and ulcerative colitis. Nat Clin Pract Gastroenterol Hepatol. 2006;3:390–407.CrossRefPubMedGoogle Scholar
  5. 5.
    Marks DJ, Segal AW. Innate immunity in inflammatory bowel disease: a disease hypothesis. J Pathol. 2008;214:260–266.CrossRefPubMedGoogle Scholar
  6. 6.
    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.CrossRefPubMedGoogle Scholar
  7. 7.
    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.CrossRefPubMedGoogle Scholar
  8. 8.
    Arnold GL, Beaves MR, Pryjdun VO, Mook WJ. Preliminary study of ciprofloxacin in active Crohn’s disease. Inflamm Bowel Dis. 2002;8:10–15.CrossRefPubMedGoogle Scholar
  9. 9.
    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.CrossRefPubMedGoogle Scholar
  10. 10.
    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.CrossRefPubMedGoogle Scholar
  11. 11.
    Leiper K, Morris AI, Rhodes JM. Open label trial of oral clarithromycin in active Crohn’s disease. Aliment Pharmacol Ther. 2000;14:801–806.CrossRefPubMedGoogle Scholar
  12. 12.
    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.PubMedGoogle Scholar
  13. 13.
    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.CrossRefPubMedGoogle Scholar
  14. 14.
    Sutherland L, Singleton J, Sessions J, et al. Double blind, placebo-controlled trial of metronidazole in Crohn’s disease. Gut. 1991;32:1071–1075.CrossRefPubMedGoogle Scholar
  15. 15.
    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.PubMedGoogle Scholar
  16. 16.
    Buning C, Lochs H. Conventional therapy for Crohn’s disease. World J Gastroenterol. 2006;12:4794–4806.PubMedGoogle Scholar
  17. 17.
    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.CrossRefPubMedGoogle Scholar
  18. 18.
    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.PubMedGoogle Scholar
  19. 19.
    Steffen R, Sack DA, Riopel L, et al. Therapy of travelers’ diarrhea with rifaximin on various continents. Am J Gastroenterol. 2003;98:1073–1078.CrossRefPubMedGoogle Scholar
  20. 20.
    Jiang ZD, DuPont HL. Rifaximin: in vitro and in vivo antibacterial activity—a review. Chemotherapy. 2005;51(suppl 1):67–72.CrossRefPubMedGoogle Scholar
  21. 21.
    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.CrossRefPubMedGoogle Scholar
  22. 22.
    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.PubMedGoogle Scholar
  23. 23.
    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.CrossRefPubMedGoogle Scholar
  24. 24.
    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.CrossRefPubMedGoogle Scholar
  25. 25.
    Gionchetti P, Rizzello F, Lammers KM, et al. Antibiotics and probiotics in treatment of inflammatory bowel disease. World J Gastroenterol. 2006;12:3306–3313.PubMedGoogle Scholar
  26. 26.
    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.CrossRefPubMedGoogle Scholar
  27. 27.
    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.CrossRefPubMedGoogle Scholar
  28. 28.
    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.CrossRefPubMedGoogle Scholar
  29. 29.
    Shafran I, Burgunder P. Rifaximin for the treatment of newly diagnosed Crohn’s disease: a case series. Am J Gastroenterol. 2008;103:2158–2160.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Shafran Gastroenterology CenterWinter ParkUSA

Personalised recommendations