Rifaximin may prevent multiple recurrences of CDAD

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Data indicate that oral rifaximin can prevent recurrences of Clostridium difficile-associated diarrhea (CDAD) in patients treated previously with vancomycin, said presenters at the American College of Gastroenterology Annual Scientific Meeting (ACG) in Las Vegas, Nev.

Data indicate that oral rifaximin can prevent recurrences of Clostridium difficile-associated diarrhea (CDAD) in patients treated previously with vancomycin, said presenters at the American College of Gastroenterology Annual Scientific Meeting (ACG) in Las Vegas, Nev.

Metronidazole and vancomycin are the 2 therapies most commonly used to treat CDAD, and although most patients will respond to 1 of these therapies, diarrhea recurs in ≥20% of cases. Furthermore, fulminant disease has resulted in colectomies, clinical sepsis, and death.

"We're aiming to interrupt the cycle of multiple recurrences of C difficile," said Stuart Johnson, MD, associate professor of medicine, Loyola University, Chicago, Ill. "About 1 in 5 have a recurrence, and a smaller group has multiple recurrences in whom the symptoms come back within days or weeks of stopping vancomycin."

After treatment with rifaximin, "6 of the 7 patients had no further CDAD episodes when followed for 2 to 12 months," Dr Johnson said. The exception was a dialysis patient whose symptoms eventually resolved but who developed a resistant isolate. Two patients required additional antibiotics for the treatment of urinary tract infections within weeks of stopping rifaximin.

In a prospective, open-label trial also presented at the ACG meeting, rifaximin 400 mg 3 times daily was studied as first-line therapy in 13 patients (5 men and 8 women) with CDAD. Eight patients completed the protocol, receiving rifaximin for 10 days. Seven of the 8 patients responded to therapy at Day 10 and had no relapses at 2 weeks.

Longer-term follow-up for a median of 162 days demonstrated 1 confirmed case of CDAD at 52 days in a patient with a prolonged hospitalization after placement of a ventricular assist device.

Another study of 19 patients with newly diagnosed or recurrent CDAD found complete resolution of symptoms in 17 patients (89%) after treatment with rifaximin 400 mg 2 or 3 times daily for 10 to 14 days.

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