Antimicrobials in the Management of Inflammatory Bowel DiseaseGionchetti P. · Rizzello F. · Lammers K.M. · Morselli C. · Tambasco R. · Campieri M.
Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy
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Many experimental and clinical observations suggest a potential role for intestinal microflora in the pathogenesis of inflammatory bowel disease (IBD). Manipulation of the luminal content using antibiotics may therefore represent a potentially effective therapeutic option. However, the available studies do not support the use of antimicrobials in ulcerative colitis and larger studies are required. These drugs are however effective in treating septic complications of Crohn’s disease (CD). The use of antibacterial agents as primary therapy for CD is more controversial, although this approach is frequently and successfully adopted in clinical practice. Despite the fact that properly controlled trials have been not carried out, antimicrobials are the mainstay of the treatment of pouchitis. Rifaximin is a poorly absorbed, broad-spectrum antibiotic that, thanks to its efficacy and long-term safety, could represent the preferred tool of manipulating enteric flora in patients with IBD. Preliminary data suggest that rifaximin may be beneficial in the treatment of active ulcerative colitis (and pouchitis), mild to moderate CD as well as prevention of post-operative recurrence of CD.
© 2006 S. Karger AG, Basel
Note Added in Proof
After submission of this paper some authors reported at the meeting of the American College of Gastroenterology in Honolulu (Hawaii, USA) their experience with rifaximin in IBD. The steroid-sparing activity of this poorly absorbed antibiotic was confirmed not only in CD [59, 60] but also in UC . The drug proved to be effec tive – as an add-on medication – in patients with mild to moderately active CD with 75% of them achieving a complete (67%) or partial (33%) response in a median time of 21 (14–30) days . Of those who did not respond to antibiotic treatment, the majority had ileocolic CD.
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