Cyclic antibiotic therapy for diverticular disease: a critical reappraisal.

Different symptoms have been attributed to uncomplicated diverticular disease (DD). Poor absorbable antibiotics are largely used for uncomplicated DD, mainly for symptom treatment and prevention of diverticulitis onset. Controlled trials on cyclic administration of rifaximin in DD patients were evaluated. Four controlled, including 1 double-blind and 3 open-label, randomized studies were available. Following a long-term cyclic therapy, a significant difference emerged in the global symptoms score (range: 0-18) between rifaximin plus fibers (from 6-6.5 to 1-2) and fibers alone (from 6.7 to 2-3.8), although the actual clinically relevance of such a very small difference remains to be ascertained. Moreover, a similar global symptom score reduction (from 6 to 2.4) can be achieved by simply recommending an inexpensive high-fiber diet. Current data suggest that cyclic rifaximin plus fibers significantly reduce the incidence of the first episode of acute diverticulitis as compared to fibers alone (1.03% vs 2.75%), but a cost-efficacy analysis is needed before this treatment can be routinely recommended. The available studies have been hampered by some limitations, and definite conclusions could not be drawn. The cost of a long-life, cyclic rifaximin therapy administered to all symptomatic DD patients would appear prohibitive.

[Feasibility of colorectal cancer screening with fecal occult blood test distributed by public pharmacies]. / Studio di fattibilità per lo screening del cancro del colon retto con sangue occulto fecale, mediante le farmacie comunali.

We conducted a colorectal cancer (CRC) screening program, in which public pharmacies provided the faecal occult blood test (FOBT), addressed to 50-70 years residents of 12th Municipality of Rome. A total of 5003 subjects were invited and 1103 (22.0%) performed the screening test, the adjusted compliance was 24.0%. Among 72 (6.5%) FOBT-positive subjects, 50 (69.5%) had colonoscopies; a CRC was detected in 5 subjects. Screening through the public pharmacies was feasible but the limited number of pharmacies enrolled have influenced compliance. A screening model that offers multiple providers (including private pharmacies) should be tested in order to improve screening compliance.