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Rationale for the use of rifaximin in inflammatory bowel diseases based on clinical trial results

Roberto Lorenzetti, Cosimo Prantera

The cause of inflammatory bowel disease is not completely understood. However, there is now a strong evidence that resident intestinal bacteria, which are normally considered to be commensal, can initiate the pathological inflammation in a susceptible host. Although this may be a good rationale for antibiotic use in the treatment of these diseases, previous trials with different antibiotics have given controversial results while their long-term use is accompanied by an elevated number of adverse events. Rifaximin is an oral, minimally absorbed (<1% of the ingested dose), antimicrobial agent that exerts its bactericidal activity in the intestinal lumen, and is apparently free of systemic side effects. The efficacy of a new gastroresistant formulation of rifaximin (rifaximin-extended intestinal release) in moderately active Crohn’s disease has been recently shown in a multicenter, randomized, double-blind trial. In open-label studies promising results have also been obtained in ulcerative colitis and pouchitis. These findings need to be confirmed in larger randomized-controlled studies.