Rifaximin for maintenance therapy in antibiotic-dependent pouchitis.
BACKGROUND
Pouchitis is the most common long-term complication of in patients with restorative proctocolectomy and ileal pouch-anal anastomosis. Patients often develop antibiotic-dependent form of pouchitis requiring long-term antibiotic therapy for remission maintenance. Rifaximin, an oral, non-systemic, broad-spectrum antibiotic with a favorable safety profile, may be a promising candidate agent for maintenance therapy. This historical cohort open-label study investigated the efficacy and tolerability of rifaximin in maintaining symptomatic and endoscopic remission in patients with antibiotic-dependent pouchitis.


METHODS
Adult patients with antibiotic-dependent pouchitis received a 2-week course of various antibiotics for induction of remission. Patients in remission then began maintenance therapy with rifaximin 200 mg/day (to 1800 mg/day) for up to 24 months. Pouchitis Disease Activity Index symptom scores were assessed every 1-3 months to evaluate efficacy.


RESULTS
Fifty-one patients began maintenance therapy with rifaximin (median dose 200 mg/day); 33 (65%) maintained remission through 3 months (primary endpoint). Of these 33 patients, 26 (79%) successfully continued maintenance for 6 months after beginning maintenance, 19 (58%) successfully continued for 12 months, and two (6%) successfully continued for 24 months. Only one patient reported an adverse event (transient facial rash).


CONCLUSIONS
Patients' response to rifaximin as a maintenance therapy appears to be favorable in this open-labeled trial of antibiotic-dependent pouchitis. Randomized, placebo-controlled trials with a longer follow-up are warranted.
The Pouchitis Clinic, Digestive Disease Institute, The Cleveland Clinic, Cleveland, OH 44195, USA. shenb@ccf.org
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Feza H
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Remzi
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Queener
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000601:surgery; D004352:Drug Resistance, Microbial; D006801:Humans; D019449:Pouchitis / Q000188:drug therapy* / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects; D012008:Recurrence; D012074:Remission Induction; D012294:Rifamycins / Q000627:therapeutic use*; D000078262:Rifaximin
D000900:Anti-Bacterial Agents; D012294:Rifamycins; D000078262:Rifaximin