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INFECTIOUS DISEASES

Rifamycin Antibiotics for Treatment of Clostridium difficile–Associated Diarrhea

Associate Professor and Chair, Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Houston, TX

Miguel Salazar, PhD PharmD

Clinical Coordinator, Department of Pharmacy, St. Luke's Episcopal Hospital, Houston, TX

Dhara Shah

PharmD Student, Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston

Richard Rodrigue

PharmD Student, Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston

Herbert L DuPont, MD

Professor, School of Public Health and Baylor College of Medicine, University of Texas—Houston; Chief of Internal Medicine, St. Luke's Episcopal Hospital

Reprints: Dr. Garey, Texas Medical Center, University of Houston College of Pharmacy, 1441 Moursund St., Houston TX 77030, fax 713/795-8383, kgarey{at}uh.edu

OBJECTIVE: To review the existing data on use of the rifamycin class of antibiotics as therapy for Clostridium difficile–associated diarrhea (CDAD).

DATA SOURCES: A literature search was performed using PubMed (1996–January 2008), abstracts from the International Conference on Antimicrobial Agents and Chemotherapy (September 2007), the Infectious Diseases Society of America (October 2007), Salix Pharmaceuticals Web site (January 2008), ActivBiotics Web site (January 2008), Google Scholar, and searches of selected bibliographies using the terms rifamycin, ansamycins, rifampin, rifabutin, rifampicin, rifaximin, rifalazil, Clostridium difficile, C. difficile, and CDAD.

STUDY SELECTION AND DATA EXTRACTION: In vivo and in vitro studies investigating the use of rifamycins for CDAD were selected, along with all clinical trials using rifamycins in patients with CDAD.

DATA SYNTHESIS: Nine studies totaling 890 isolates were identified that investigated the in vitro susceptibility of rifampin (6 studies), rifaximin (3 studies), and rifalazil (2 studies). Rifamycins consistently displayed potent activity against tested strains, although strains with decreased susceptibility have been identified. Six published clinical studies involving 81 patients have investigated the use of rifamycins for the treatment of CDAD. These have generally been small studies, although initial positive clinical results have been reported on the use of rifamycins for recurrent CDAD.

CONCLUSIONS: Preliminary data support the use of rifamycins for treatment of CDAD. With the increased incidence and severity of CDAD, further investigation into this drug class as a treatment regimen for CDAD is warranted.

Key Words: Clostridium difficile diarrhea, rifamycin

Published Online, April 22, 2008. www.theannals.com, DOI 10.1345/aph.1K675

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-08-011-H01-P