Bret T. Petersen, MD, FASGE

Associate Editor



Bret T. Petersen, MD, FASGE is Professor of Medicine in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, Minnesota. His practice is focused in the Mayo Pancreas Clinic and the Advanced Endoscopy Group. His professional interests include pancreatic and biliary diseases, performance and outcomes of ERCP, and delivery of endoscopic services. At Mayo, Dr. Petersen is a past Director of Endoscopy and has served on multiple clinic and foundation committees. He has directed numerous American Society for Gastrointestinal Endoscopy (ASGE) and Mayo courses, particularly related to the performance of ERCP. He has received the Mayo Award for Excellence, GI Fellows Award for Outstanding Teacher, and Department of Medicine Laureate Award (GI), as well as the Master Endoscopist Award of the ASGE. Dr. Petersen is the incoming Secretary for (ASGE) and a past Chair of the Technology and Quality Assurance in Endoscopy committees.



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Post-Treatment Rifaximin Reduces Clostridium Difficile Recurrence

Bret T. Petersen, MD, FASGE reviewing Major G, et al. Gut 2018 Sep 25.

Clinical infection associated with Clostridium difficile (CDAI) recurs in 15-30% of patients. This multi-center, randomized, placebo-controlled study (RAPID Trial) evaluated whether post-treatment prophylaxis with ongoing rifaximin would reduce the recurrence rate. After initial therapy with metronidazole or vancomycin, 151 patients (mean 71.9 year) received placebo therapy or rifaximin 400mg three times daily for 2 weeks then 200mg three times daily for 2 weeks. Among 130 evaluable patients, recurrence within 12 weeks of study entry was more common in those receiving placebo (29.5% vs 15.9%; 95% CI −28.1% to 0.7%, p=0.06). Adverse events were similar between groups and 9 patients in each group died during further 6 month follow-up. The authors noted that rifaximin appeared to cut the recurrence rate in half, but failure to reach statistical significance was likely due, in part, to challenges reaching their recruitment target.


While this study failed to reach the necessary and planned recruitment of 180 patients prior to closure and end of funding, the authors provided a meta-analysis combining results with a similar smaller trial, yielding an overall absolute reduction in risk of CDAI recurrence of 14% (95% CI -26% to -3%; p=0.01). This is similar to the prevention of recurrence seen in recent trials of several novel and potentially costly antibiotic and monoclocal antibody therapies that were deemed cost effective when used for primary therapy and/or secondary prevention. Rifaximin is attractive because of its low systemic bioavailability and reported modest effect on fecal microbiota. Fecal transplantation is likely most efficacious for those with multiple episodes of recurrence.

Bret T. Petersen, MD, FASGE
Bio and Disclosures

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Major G, Bradshaw L, Boota N, et al. Follow-on RifAximin for the Prevention of recurrence following standard treatment of Infection with Clostridium Difficile (RAPID): a randomised placebo controlled trial. Gut 2018 Sep 25. (Epub ahead of print) (