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Rifaximin in the treatment of recurrent Clostridium difficile infection

  1. E. Mattila1,*,
  2. P. Arkkila2,
  3. P. S. Mattila3,
  4. E. Tarkka4,
  5. P. Tissari4,
  6. V.-J. Anttila1

Article first published online: 24 OCT 2012

DOI: 10.1111/apt.12111

Issue

Alimentary Pharmacology & Therapeutics

Alimentary Pharmacology & Therapeutics

Volume 37, Issue 1, pages 122–128, January 2013

Additional Information

How to Cite

Mattila, E., Arkkila, P., Mattila, P. S., Tarkka, E., Tissari, P. and Anttila, V.-J. (2013), Rifaximin in the treatment of recurrent Clostridium difficile infection. Alimentary Pharmacology & Therapeutics, 37: 122–128. doi: 10.1111/apt.12111

Author Information

  1. 1

    Department of Infectious Diseases, Helsinki University Central Hospital, Helsinki, Finland

  2. 2

    Department of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland

  3. 3

    Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland

  4. 4

    Division of Clinical Microbiology, HUSLAB, Helsinki University Central Hospital, Helsinki, Finland

* Correspondence to:
Dr E. Mattila, Department of Infectious Diseases, Helsinki University Central Hospital, PO Box 348, FIN-00029 HUS, Helsinki, Finland.
E-mail: eero.mattila@hus.fi

Publication History

  1. Issue published online: 4 DEC 2012
  2. Article first published online: 24 OCT 2012
  3. Manuscript Revised: 8 OCT 2012
  4. Manuscript Accepted: 8 OCT 2012
  5. Manuscript Revised: 29 AUG 2012
  6. Manuscript Received: 15 AUG 2012

Funded by

  • Finnish Foundation for Gastroenterological Research
  • EVO funds of Helsinki University Central Hospital

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Summary

Background

Clostridium difficile can cause severe antibiotic-associated colitis. Conventional treatments with metronidazole and vancomycin improve symptoms, but after discontinuation of treatment, C. difficile infection (CDI) recurs in a number of patients. Rifaximin is a rifamycin-based non-systemic antibiotic that has effect against C. difficile.

Aim

To assess the effectiveness of rifaximin in recurrent C. difficile infection.

Methods

We retrospectively evaluated the records of 32 patients who were treated with rifaximin for recurrent C. difficile infection. The symptoms were evaluated 12 weeks after the start of treatment and patient records were followed up until 1 year after treatment.

Results

The mean age of the patients was 55 years (median 64, range: 19–84 years). Before the initiation of rifaximin therapy, the patients had undergone, on the average, 4.4 (range: 2–12) antimicrobial courses for C. difficile infection. C. difficile strain typing was performed in 27 patients. Eight (30%) patients had a strain with a DNA profile compatible with the BI/NAP1/027 ribotype. Antibiotic susceptibilities were determined of isolates from 22 patients. Most isolates (68%) had very low MIC-values for rifampin (<0.002 μg/mL) and the highest MIC value was 3.0 μg/mL. Isolates with a DNA profile compatible with the BI/NAP1/027 ribotype had, on the average, higher MICs of rifampin. After 12 weeks 17 (53%) patients had no relapse. The MIC value of rifampin seemed to predict the response to rifaximin treatment.

Conclusions

Rifaximin is a safe treatment for C. difficile infection. It has a reasonable effect in C. difficile infection and it can be considered as an optional treatment for recurrent C. difficile infection.

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