Friday, October 5, 2018

Antibiotic for pruritus associated with cholestasis

Q: Which of the following antibiotic has shown benefit in pruritis associated with cholestasis?

A) Cefepime
B) Ceftriaxone
C) Ciprofloxacine
D) Rifampin 
E) Meropenem 

Answer: D

Rifampin is a potent agonist of the pregnane X receptor, a mediator for various detoxification and hepatobiliary processes. This gives rifampin a unique advantage among all antibiotics as an antipruritic agent. But rifampin itself can cause increased liver enzymes so it should be used only if needed as an alternative agent.




1. Podesta A, Lopez P, Terg R, et al. Treatment of pruritus of primary biliary cirrhosis with rifampin. Dig Dis Sci 1991; 36:216. 

2. Ghent CN, Carruthers SG. Treatment of pruritus in primary biliary cirrhosis with rifampin. Results of a double-blind, crossover, randomized trial. Gastroenterology 1988; 94:488.

3.  Khurana S, Singh P. Rifampin is safe for treatment of pruritus due to chronic cholestasis: a meta-analysis of prospective randomized-controlled trials. Liver Int 2006; 26:943.

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