Joe Alcorn, MD
Is rifaximin effective and safe for treatment of hepatic encephalopathy?
Studies selected compared rifaximin with placebo, another antimicrobial agent, or a nonabsorbable disaccharide for treatment of hepatic encephalopathy. Outcomes were improvements in signs or symptoms of hepatic encephalopathy, including mental status, asterixis, blood ammonia level, electroencephalographic abnormalities, and intellectual function.
MEDLINE, Cochrane Database of Systemic Reviews, and Cochrane Hepato-Biliary Group Reviews (to Sep 2007), and reference lists were searched for clinical trials that included ≥ 20 patients. 14 randomized controlled trials (RCTs) (n = 650) and 3 cohort studies (n = 161) met the selection criteria. 7 RCTs were blinded. Duration of treatment ranged from 5 to 21 days, except for 1 trial that gave intermittent treatment for 6 months. The dose of rifaximin was usually 400 mg 3 times/d.
The Table shows the results. Side effects (mainly gastrointestinal symptoms) were similar or less frequent with rifaximin than with other drugs.
In patients with hepatic encephalopathy, rifaximin is as effective as other antibiotics and may be more effective than nonabsorbable disaccharides.
Rifaximin (rif) for hepatic encephalopathy at 5 to 30 days*
*BAL = blood ammonia level; PSE = portal-systemic encephalopathy (score includes 5 elements: mental status, asterixis, intellectual function, BAL, and electroencephalographic abnormalities); RCT = randomized controlled trial.
†Paromomycin in 4 RCTs and neomycin in 3 RCTs.
‡Lactulose in 4 RCTs and lactitol in 1 RCT.
Alcorn J. Review: Rifaximin is equally or more effective than other antibiotics and lactulose for hepatic encephalopathy. Ann Intern Med. 2008;149:JC5–11. doi: 10.7326/0003-4819-149-10-200811180-02011
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Published: Ann Intern Med. 2008;149(10):JC5-11.
Encephalopathy, Gastroenterology/Hepatology, Liver Disease, Neurology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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