Use of rifampin for severe pruritus in children with chronic cholestasis

Baruch Yerushalmi, Ronald J. Sokol, Michael R. Narkewicz, Debra Smith, Frederick M. Karrer

Research output: Contribution to journalArticlepeer-review

83 Scopus citations

Abstract

Background: Rifampin has been proposed to reduce pruritus in children and adults with chronic cholestasis; however, there is a paucity of published data regarding the use of rifampin in children. Methods: In an open trial, 24 children were evaluated during a 6-year period. Diagnoses included 13 patients with extrahepatic biliary atresia (54%), six with Alagille's syndrome, three with Byler's disease, and one each with primary sclerosing cholangitis and α1-antitrypsin deficiency. All patients had severe pruritus that had not responded adequately to at least 2 months of therapy with ursodeoxycholic acid, diphenhydramine, or phenobarbital and local skin care measures. Treatment was initiated with rifampin, 10 mg/kg per day in two divided doses for 18 ± 20 months, and the effect on the severity of pruritus was assessed by a clinical scoring system. Results: Ten patients showed a complete response, 12 a partial response, and 2 no response. Complete response was more common in extrahepatic cholestasis (64% vs. 10%), whereas partial response was more common in intrahepatic cholestasis (80% vs. 29%). Treatment was associated with reduction of γ-glutamyl transpeptidase. No clinical or biochemical toxicity of rifampin was observed. Conclusions: We conclude that for more than 90% of children with chronic cholestasis and severe pruritus unresponsive to other treatments, rifampin appears to be a safe and effective therapy. (C) 1999 Lippincott Williams and Wilkins, Inc.

Original languageEnglish
Pages (from-to)442-447
Number of pages6
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume29
Issue number4
DOIs
StatePublished - 1 Oct 1999
Externally publishedYes

Keywords

  • Alagille's syndrome
  • Bile acids
  • Biliary atresia
  • Opioid receptors
  • Pruritus
  • Rifampin
  • Ursodeoxycholic acid

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology

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