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Rifaximin-ciprofloxacin combination therapy is effective in chronic active refractory pouchitis.
A S Abdelrazeq1, S M Kelly, J N Lund
1Department of General Surgery, Hull and York Medical School, York, UK. aymonrazeq@yahoo.co.uk
Summary
The combination of rifaximin and ciprofloxacin effectively treats chronic active refractory pouchitis, leading to remission or improvement in most patients. This safe and well-tolerated therapy can salvage pouches at risk of failure.
Area of Science:
- Gastroenterology
- Inflammatory Bowel Disease
- Microbiome Research
Background:
- Chronic refractory pouchitis presents a significant treatment challenge, often leading to pouch failure.
- Existing therapies for chronic active refractory pouchitis have limited efficacy and tolerability.
- Nonabsorbable oral antibiotics with immunomodulatory properties offer a potential therapeutic avenue.
Purpose of the Study:
- To evaluate the efficacy and tolerability of a combination therapy using rifaximin and ciprofloxacin for chronic active refractory pouchitis.
- To assess the impact of this combination therapy on Pouchitis Disease Activity Index (PDAI) scores.
- To determine the long-term outcomes and pouch salvage rates in patients treated with rifaximin and ciprofloxacin.
Main Methods:
- Eight patients with chronic active refractory pouchitis received oral rifaximin (1 g b.d.) and ciprofloxacin (500 mg b.d.) for two weeks.
- Clinical, endoscopic, and histological assessments were performed pre- and post-therapy using the PDAI score.
- Improvement was defined as a ≥3-point PDAI decrease; remission was a PDAI score of 0. Long-term outcomes were prospectively monitored.
Main Results:
- Seven out of eight patients achieved remission (n=5) or improvement (n=2) based on PDAI scores (P=0.018).
- Median PDAI scores decreased significantly from 12 (9-18) to 0 (0-15) post-treatment.
- No side effects were reported, and seven patients maintained satisfactory pouch function at a median 30-month follow-up, with two experiencing recurrence managed by repeat courses.
Conclusions:
- Rifaximin-ciprofloxacin combination therapy demonstrates objective efficacy and safety in treating chronic active refractory pouchitis.
- This therapeutic approach may salvage a significant proportion of pouches at risk of failure.
- The combination therapy offers a promising option for managing difficult-to-treat pouchitis, potentially improving long-term pouch survival.