Abstract Title:

Cyclic antibiotic therapy for diverticular disease: a critical reappraisal.

Abstract Source:

J Gastrointestin Liver Dis. 2010 Sep;19(3):295-302. PMID: 20922195

Abstract Author(s):

Angelo Zullo, Cesare Hassan, Giovanni Maconi, Gianpiero Manes, Gianfranco Tammaro, Vincenzo De Francesco, Bruno Annibale, Leonardo Ficano, Luigi Buri, Giovanni Gatto, Roberto Lorenzetti, Salvatore M Campo, Enzo Ierardi, Fabio Pace, Sergio Morini

Article Affiliation:

Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy. zullo66@yahoo.it

Abstract:

Different symptoms have been attributed to uncomplicated diverticular disease (DD). Poor absorbable antibiotics are largely used for uncomplicated DD, mainly for symptom treatment and prevention of diverticulitis onset. Controlled trials on cyclic administration of rifaximin in DD patients were evaluated. Four controlled, including 1 double-blind and 3 open-label, randomized studies were available. Following a long-term cyclic therapy, a significant difference emerged in the global symptoms score (range: 0-18) between rifaximin plus fibers (from 6-6.5 to 1-2) and fibers alone (from 6.7 to 2-3.8), although the actual clinically relevance of such a very small difference remains to be ascertained. Moreover, a similar global symptom score reduction (from 6 to 2.4) can be achieved by simply recommending an inexpensive high-fiber diet. Current data suggest that cyclic rifaximin plus fibers significantly reduce the incidence of the first episode of acute diverticulitis as compared to fibers alone (1.03% vs 2.75%), but a cost-efficacy analysis is needed before this treatment can be routinely recommended. The available studies have been hampered by some limitations, and definite conclusions could not be drawn. The cost of a long-life, cyclic rifaximin therapy administered to all symptomatic DD patients would appear prohibitive.

Study Type : Human Study

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