Antibiotic combination therapy in patients with chronic, treatment-resistant pouchitis.
Aliment Pharmacol Ther
; 13(6): 713-8, 1999 Jun.
Article
en En
| MEDLINE
| ID: mdl-10383499
ABSTRACT
BACKGROUND:
Pouchitis is the major long-term complication after ileal pouch-anal anastomosis for ulcerative colitis. About 15% of patients have a chronic, treatment-resistant disease.AIMS:
To evaluate the efficacy of an antibiotic combination for chronic active, treatment-resistant pouchitis. PATIENTS ANDMETHODS:
Eighteen patients were treated orally with rifaximin 1 g b.d. + ciprofloxacin 500 mg b.d. for 15 days. Symptoms assessment, endoscopic and histological evaluations were performed at screening and after 15 days using the Pouchitis Disease Activity Index (PDAI). Improvement was defined as a decrease of at least 3 points in PDAI score, and remission as a PDAI score of 0. Systemic absorption of rifaximin was determined by high performance liquid chromatography. Faecal samples were collected before and after antibiotic treatment for stool culture.RESULTS:
Sixteen out of 18 patients (88.8%) either improved (n=10) or went into remission (n=6); the median PDAI scores before and after therapy were 11 (range 9-17) and 4 (range 0-16), respectively (P < 0.002). No side-effects were reported. Rifaximin plasma levels and urinary excretion were negligible, confirming its mainly topical activity. A significant decrease in total anaerobes and aerobes, enterococci, lactobacilli, bifidobacteria and bacteroides in faecal samples was observed, while the reduction in number of coliforms and Clostridium perfringens did not reach a statistical significance.CONCLUSIONS:
A combination of rifaximin and ciprofloxacin was effective in patients with active chronic, treatment-resistant pouchitis, suggesting the need, in these patients, for treatment using antibiotic agents with wide antibacterial spectrum of activity.
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Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Rifamicinas
/
Ciprofloxacina
/
Reservoritis
/
Quimioterapia Combinada
Límite:
Adult
/
Female
/
Humans
/
Male
Idioma:
En
Revista:
Aliment Pharmacol Ther
Asunto de la revista:
FARMACOLOGIA
/
GASTROENTEROLOGIA
/
TERAPIA POR MEDICAMENTOS
Año:
1999
Tipo del documento:
Article
País de afiliación:
Italia