Cyclic rifaximin treatment in uncomplicated colonic diverticular disease – results of an open study

Introduction: Aquired diverticular disease of the colon is extremely common in developed countries. The disease may cause several abdominal complaints and diverticulitis as a serious complication. Poorly absorbable antibiotics may have favourable results in long-term treatment.

Aims: An open study was conducted to evaluate the efficiency of rifaximin in prevention of complaints and recurrent diverticulitis. Patients and methods: 30 patients with known (actually uncomplicated) diverticular disease of the colon – but occurrence of diverticulitis in previous history – were elected to receive rifaximin 200mg bid for the first six days of every month, for 6 months. High-fibre diet was proposed. Basic laboratory studies (WBC, sedimentation rate and CRP) were performed at the 1st, 4th visit and at the end of the study. Patients were reviewed on a monthly basis by clinical examinations: changes in symptom variables (lower abdominal pain, upper abdominal pain, bloating, tenesmus, diarrhea, abdominal tenderness) were evaluated on a 10-points Visual Analogue Scale (VAS), and presence of acute diverticulitis (abdominal mass, fever, US) was excluded by every month visits.

Results: all of 30 included patients completed the study. After 6 months of cyclic rifaximin treatment 83% of patients showed lower global symptomatic score in comparison with the time of inclusion (self-controlled). Acute diverticulitis, other complication or side effects were not observed. Most effective self-controlled improvement was mentioned regarding lower abdominal pain, tenesmus, bloating and abdominal tenderness. Initially elevated CRP and ESR levels were diminished in five cases, and remained normal in the others. Conclusions: Cyclic administration of relative low dose rifaximin in uncomplicated colonic diverticular disease resulted in reducing abdominal complaints and prevention recurrent diverticulitis. This effect probably may be explained by reduction metabolic activity of intestinal bacterial flora. Further placebo controlled studies are needed to prove the benefit of cyclic rifaximin treatment in uncomplicated diverticular disease.