Abdelrazeq A S, Kelly S M, Lund J N, Leveson S H
Department of General Surgery, Hull and York Medical School, York, UK.
Colorectal Dis. 2005 Mar;7(2):182-6. doi: 10.1111/j.1463-1318.2004.00746.x.
Treatment of chronic refractory pouchitis is often difficult and disappointing and some of the affected pouches subsequently fail. This study was conducted to evaluate the efficacy and tolerability of treatment with rifaximin, a nonabsorbable oral antibiotic with immunomdulatory functions, in combination with ciprofloxacin for chronic active refractory pouchitis.
Eight patients with chronic active refractory pouchitis were treated orally with a combination of rifaximin 1 g b.d and ciprofloxacin 500 mg b.d. for two weeks. Clinical assessment, endoscopic and histological evaluations were performed before and after therapy using the Pouchitis Disease Activity Index (PDAI) score. Improvement was defined as a decrease of at least three points in the PDAI score and remission as a PDAI score of 0. The Wilcoxon signed rank test was used to compare pre- and post-treatment PDAI scores. The long-term outcome of the treated patients was prospectively monitored.
Seven of the eight patients either went into remission (n = 5) or improved (n = 2). The median (range) PDAI scores before and after therapy were 12 (9-18) and 0 (0-15), respectively, (P = 0.018). All patients were compliant and no side effects were reported. Pouchitis recurred in two of the seven responding patients but returned into remission after further courses of the same combination. After a median follow-up of 30 months, the seven responding patients still had satisfactory pouch function.
Rifaximin-ciprofloxacin combination therapy is safe and objectively effective in chronic active refractory pouchitis and may salvage a significant percentage of 'at risk pouches'.
慢性难治性袋炎的治疗往往困难且不尽人意，部分受累肠袋随后会失效。本研究旨在评估利福昔明（一种具有免疫调节功能的非吸收性口服抗生素）联合环丙沙星治疗慢性活动性难治性袋炎的疗效和耐受性。
8例慢性活动性难治性袋炎患者口服利福昔明1g，每日2次，联合环丙沙星500mg，每日2次，疗程为两周。治疗前后采用袋炎疾病活动指数（PDAI）评分进行临床评估、内镜和组织学评价。改善定义为PDAI评分至少降低3分，缓解定义为PDAI评分为0。采用Wilcoxon符号秩检验比较治疗前后的PDAI评分。对治疗患者的长期预后进行前瞻性监测。
8例患者中有7例缓解（n = 5）或改善（n = 2）。治疗前后PDAI评分的中位数（范围）分别为12（9 - 18）和0（0 - 15），（P = 0.018）。所有患者均依从性良好，未报告副作用。7例有反应的患者中有2例袋炎复发，但在再次使用相同联合治疗后恢复缓解。中位随访30个月后，7例有反应的患者肠袋功能仍令人满意。
利福昔明 - 环丙沙星联合治疗慢性活动性难治性袋炎安全且客观有效，可能挽救相当比例的“高危肠袋”。
