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.

#hepatology
#pharmacology


References:

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.