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Rifaximin Is An Effective Antibiotic for the Treatment of Pouchitis
Leonard Baidoo, Graduate Hospital, Philadelphia, PA; Rabi Kundu, Chinyu Su, James D. Lewis, University of Pennsylvania School of Medicine, Philadelphia, PA; Robert Stein, Abington Memorial Hospital, Abington, PA; Wojciech Bronski, Gary R. Lichtenstein, University of Pennsylvania School of Medicine, Philadelphia, PA
Background: 15% to 50% of pts who undergo an IPAA for medically refractory ulcerative colitis (UC), dysplasia or colorectal cancer will develop pouchitis. Pouchitis has traditionally been treated with antibiotics (e.g. metronidazole or ciprofloxacin). Their use is often limited by adverse effects (AEs); metronidazole is commonly associated with the development of nausea, anorexia, a metallic taste and peripheral neuropathy. Ciprofloxacin is associated with nausea, drug interactions, tendonitis and spontaneous tendon ruptures. Resistance to metronidazole and ciprofloxacin may occur in 15%-30% of pts (JAMA 2003; 289(7):885). Rifaximin, a new orally administered poorly absorbed (< 0.4%) antibiotic, with virtually no bacterial resistance was recently introduced in the US for traveler's diarrhea. Its utility in pouchitis has not been critically evaluated. We report on our open label experience with use of this antibiotic for treatment of pouchitis.
Methods: Since its introduction in the US Rifaximin (Xifaxan®) was evaluated in an open label study to assess its efficacy, tolerability, and side effect profile when used to treat pouchitis. Ten pts were prospectively evaluated who presenting with classic symptoms of pouchitis All pts had current (n=6) or recent (n=4) endoscopies of their pouch consistent with pouchitis. Rifaximin was given at a dose of 400 mg po BID x 14 days. Pts were evaluated in the office or via telephone contact and assessed for response (None, < 50%, >50%, Complete Remission), time to onset of efficacy, AEs, and response to prior medications. Standard demographic data was assessed. IRB approval was obtained. Results: Mean age 42 yrs (range: 22-57 yrs), 50% were female. 90% (9 of 10) pts responded to treatment with Rifaximin. Mean time to onset of response was 3 days (range: 1-7 days) and to complete response was 7 days (range: 2-12 days). Of the 9 pts who responded 89% (8 of 9) had complete remission and 11% reported > 50% response. The mean bowel frequency decreased from 14 to 5/day. All pts also reported decreased fecal urgency and complete resolution of abdominal pain. No AEs were noted in any pts.3 pts who had remission had been refractory to ciprofloxacin 500 mg po BID. Conclusion: Our results suggest that Rifaximin is a safe and effective antibiotic for the treatment of pouchitis. These uncontrolled observations merit further evaluation in a prospective randomized placebo controlled fashion.
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