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Review
. 2023 Feb 23;12(3):443.
doi: 10.3390/antibiotics12030443.

Diverticular Disease and Rifaximin: An Evidence-Based Review

Anna Piccin  1 , Marco Gulotta  1 , Stefano di Bella  1   2 , Paola Martingano  3 , Lory Saveria Crocè  1   4 , Mauro Giuffrè  1   5
Affiliations
Review

Diverticular Disease and Rifaximin: An Evidence-Based Review

Anna Piccin et al. Antibiotics (Basel). .

Abstract

There have been considerable advances in the treatment of diverticular disease in recent years. Antibiotics are frequently used to treat symptoms and prevent complications. Rifaximin, a non-absorbable antibiotic, is a common therapeutic choice for symptomatic diverticular disease in various countries, including Italy. Because of its low systemic absorption and high concentration in stools, it is an excellent medicine for targeting the gastrointestinal tract, where it has a beneficial effect in addition to its antibacterial properties. Current evidence shows that cyclical rifaximin usage in conjunction with a high-fiber diet is safe and effective for treating symptomatic uncomplicated diverticular disease, while the cost-effectiveness of long-term treatment is unknown. The use of rifaximin to prevent recurrent diverticulitis is promising, but further studies are needed to confirm its therapeutic benefit. Unfortunately, there is no available evidence on the efficacy of rifaximin treatment for acute uncomplicated diverticulitis.

Keywords: acute diverticulitis; diverticular bleeding; diverticular disease; diverticulitis prevention; diverticulitis prophylaxis; diverticulosis; fiber supplementation; microbiota; rifaximin.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Diverticular disease is characterized by the presence of diverticula, which are small outpouchings in the lining of the colon. In most cases, diverticulosis is asymptomatic, but some people may experience changes in bowel habits such as constipation or diarrhea and vague abdominal symptoms that in same rare cases can resemble acute appendicitis, in a condition referred to as acute diverticulitis.
Figure 2
Figure 2
Diverticulitis on ultrasound imaging: (a) in the site of tenderness descending colon show a diverticulum as a bowel outpouching (arrow) surrounded by echogenic and non-compressible fat (*) with mild hypervascularization on power Doppler study; (b) a localized abscess appears as a hypoechoic fluid collection (between calipers) inside the thickened colonic wall.
Figure 3
Figure 3
Modified Hinchey classification based on CT imaging: (a) Hinchey I—colonic wall thickening (arrow) with pericolic fat stranding and a localized abscess (*); (b) Hinchey II—colonic wall thickening (arrow), important fat stranding and a pelvic abscess (*); (c) Hinchey III—colonic wall thickening (arrow), with a pelvic abscess (*) and the presence of pus in the abdominal cavity (empty arrow) circumscribed by peritoneal thickening signs of purulent peritonitis; (d) Hinchey IV—colonic wall thickening (arrow) with intestinal perforation allowing feces into abdominal cavity (*) associated to fat and peritoneal stranding (empty arrow) signs of fecal peritonitis.
Figure 4
Figure 4
Rifaximin is a non-aminoglycoside semisynthetic antibiotic derived from the natural antibiotic rifamycin. Rifaximin has a largely water-insoluble, poorly absorbable nature, with a blood bioavailability of less than 0.4% after oral administration, with the γ-polymorph having the highest systemic bioavailability. Antibiotic resistance is rare, but more common than expected.
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