Adjunctive Antibiotic Therapy with Rifaximin May Help Reduce Crohn's Disease Activity

Aims Enteric bacteria are thought to contribute to the pathogenesis of Crohn's disease, and antibiotics may be an effective therapy. This study examines the efficacy of the nonsystemic (<0.4% absorbed) antibiotic rifaximin for inducing remission in patients with Crohn's disease. Methods Data from charts of patients with Crohn's disease who received rifaximin between 2001 and 2005 and had a Crohn's disease activity index score >= 220 at the time of rifaximin initiation were analyzed. The use of concomitant medications (e.g., steroids, anti-inflammatory agents) was allowed. Results In the 68 patient charts analyzed, the median duration of rifaximin treatment was 16.6 weeks, and the majority of patients (94%) received rifaximin 600 mg/day. Eighteen patients (26%) received rifaximin monotherapy, and 31 patients (46%) received concomitant steroids. The median baseline Crohn's disease activity index score at the time of rifaximin initiation was 265 (range, 220-460), and the mean duration of Crohn's disease was 17 years (range, 1-50 years). Crohn's disease remission occurred in 65% of patients. A 70% remission rate was achieved in patients who did not receive steroids, versus 58% in patients who received steroids. Clinical improvements continued 4 months after rifaximin initiation. Remission was achieved in 67% of patients who received rifaximin monotherapy. Conclusions Rifaximin therapy was associated with clinical improvement in patients with Crohn's disease and may be a useful treatment option to consider for inducing and maintaining remission.