Rifaximin for the Secondary Prevention of Recurrent Pouchitis

Eligibility Criteria

• * Informed consent will be obtained before any study-related procedures
• * Age \> 18 and \<75 years
• * Participants with a proven history of ulcerative colitis and history of 1,2, modified -2 or 3 stage Ileal pouch anal anastomosis (IPAA) and ileostomy takedown
• * Diagnosis of initial episode of pouchitis within the first 12 months after ileostomy takedown/final stage of IPAA surgery
• * Known hypersensitivity to rifaximin or its metabolites
• * Known Crohn's disease
• * History of perianal fistula
• * Known incontinence due to anal sphincter dysfunction
• * Known irritable pouch syndrome
• * Active ongoing pelvic infection/sepsis at baseline visit
• * New onset of high bowel frequency in the setting of acute pouchitis in the first 4 weeks after IPAA
• * Known Clostridoides difficile infection
• * Need for antibiotic long-term therapy (e.g. doxycycline for acne)
• * Known active Hepatitis B, C, HIV
• * Clinically significant liver disease (Primary Sclerosing Cholangitis with LFT's \<1.5 upper limit of normal can be included)
• * Severe hepatic impairment, defined as Child-Pugh Class C
• * Concomitant use of p-glycoprotein (P-gp) inhibitors (e.g. cyclosporine)
• * Known decreased kidney function with a glomerular filtration rate \<60 ml/min/1.732
• * Fecal microbiota transplantation within 16 weeks before ileostomy takedown
• * History of malignancy, except for basal cell carcinoma, non-metastatic squamous cell carcinoma of the skin, or prior malignancy with curative therapy completed at least 5 years prior to Screening and no recurrence.
• * Clinically significant laboratory results at screening or baseline, as judged by the Investigator from local testing.
• * Female who is pregnant, breast-feeding or intends to become pregnant or is of child-bearing potential and not using a highly effective contraceptive method. Women of child-bearing potential must have a negative urine pregnancy test prior to drug being dispensed.
• * Participation in any clinical trial of an approved or non-approved investigational medicinal product within 30 days before screening.
• * Any disorder, which in the investigator's opinion might jeopardize participant's safety or compliance with the protocol.