Efficacy of long term cyclic administration of the poorly absorbed antibiotic Rifaximin in symptomatic, uncomplicated colonic diverticular disease

Abstract

AIM:To comparatively evaluate the long term efficacy of Rifaximin and dietary fibers in reducing symptoms and/or complication frequency in symptomatic, uncomplicated diverticular disease. METHODS:307 patients (118 males, 189 females, age range: 40-80 years) were enrolled in the study and randomly assigned to: Rifaximin (400 mg bid for 7 d every month) plus dietary fiber supplementation (at least 20 gr/d) or dietary fiber supplementation alone. The study duration was 24 mo; both clinical examination and symptoms' questionnaire were performed every two months. RESULTS:Both treatments reduced symptom frequency, but Rifaximin at a greater extent, when compared to basal values. Symptomatic score declined during both treatments, but a greater reduction was evident in the Rifaximin group (6.4 ± 2.8 and 6.2 ± 2.6 at enrollment, P = NS, 1.0 ± 0.7 and 2.4 ± 1.7 after 24 mo, P < 0.001, respectively). Probability of symptom reduction was higher and complication frequency lower (Kaplan-Meyer method) in the Rifaximin group (P < 0.0001 and 0.028, respectively). C O N C L U S I O N :I n p a t i e n t s w i t h s y m p t o m a t i c , uncomplicated diverticular disease, cyclic administration of Rifaximin plus dietary fiber supplementation is more effective in reducing both symptom and complication frequency than simple dietary fiber supplementation. Long term administration of the poorly absorbed antibiotic Rifaximin is safe and well tolerated by the patients, confirming the usefulness of this therapeutic strategy in the overall management of diverticular disease.

The Role of Antibiotics in Gut Microbiota Modulation: The Eubiotic Effects of Rifaximin

“…Rifaximin is a non-absorbable antibiotic derived from the macrolide rifamycin with demonstrated efficacy in inducing remission in patients with active C [15,16,17,18,19], in reducing stool frequency, rectal bleeding and sigmoidoscopic score and achieving remission in patients with U [20,21], in obtaining symptoms relief in patients with uncomplicated D [22,23,24] or I with or without constipation [25]. Rifaximin has a strong in vitro antimicrobial effect against aerobic and anaerobic Gram-positive and Gram-negative bacteria, including several pathogens such as Escherichia coli , Enterobacteriaceae and Clostridium difficile [26]; beyond this expected activity, rifaximin is supposed to have additional effects on the gut microbiota about which very little is known.…”

Review article: the current and evolving treatment of colonic diverticular disease

“…65 Multiple studies have shown that rifaximin can effectively improve symptoms and maintain periods of remission in patients with uncomplicated diverticular disease, while also being well tolerated. [66][67][68][69][70] …”

Diverticular Disease of the Colon: Resolved and Unresolved Issues

“…Рифаксимин-α используется в Италии с 1987 г. Альфа Нормикс не вызывает перекрест-ной бактериальной резистентности. Альфа Нормикс эффективен и безопасен при ежемесячном курсовом и длительном (до 4 лет) применении [21,22].…”

“…4) [23]. В рамках исследования Colecchia et al (многоцентровое проспек-тивное рандомизированное контролируемое открытое клиническое исследование у пациентов с симптоматиче-ской неосложненной дивертикулярной болезнью ободоч-ной кишки) [24] было убедительно показано, что цикличе-ское применение рифаксимина-α (400 мг х 2 р/день 7 дней/месяц) в сочетании с пищевыми волокнами (мин. 20 г/день) эффективнее терапии только пищевыми волокна-ми в уменьшении симптомов у пациентов с симптомати-ческой неосложненной дивертикулярной болезнью.…”