Rifaximin treatment in to prevent hepatic encephalopathy

January 01, 0001

Rifaximin treatment in to prevent hepatic encephalopathy

The efficacy of rifaximin, a minimally absorbed antibiotic, is well documented in the treatment of acute hepatic encephalopathy. These US authors conducted a randomized, double-blind, placebo-controlled trial to determine the efficacy of rifaximin as a preventive treatment. They randomly assigned 299 patients who were in remission from recurrent hepatic encephalopathy resulting from chronic liver disease to receive either rifaximin, at a dose of 550 mg twice daily (140 patients), or placebo (159 patients) for 6 months.

They found: "Rifaximin significantly reduced the risk of an episode of hepatic encephalopathy, as compared with placebo, over a 6-month period (hazard ratio with rifaximin 0.42). A breakthrough episode of hepatic encephalopathy occurred in 22.1% of patients in the rifaximin group, as compared with 45.9% of patients in the placebo group. A total of 13.6% of the patients in the rifaximin group had a hospitalization involving hepatic encephalopathy, as compared with 22.6% of patients in the placebo group, for a hazard ratio of 0.50. More than 90% of patients received concomitant lactulose therapy. The incidence of adverse events reported during the study was similar in the two groups, as was the incidence of serious adverse events."

The authors concluded: "Over a 6-month period, treatment with rifaximin maintained remission from hepatic encephalopathy more effectively than did placebo. Rifaximin treatment also significantly reduced the risk of hospitalization involving hepatic encephalopathy."

Good evidence for the expansion of the use of rifaximin to prevent hepatic encephalopathy.

For the full abstract, click here.

N Engl J Med 362(12):1071-1081, 25 March 2010
© 2010 to the Massachusetts Medical Society
Rifaximin Treatment in Hepatic Encephalopathy. Nathan M. Bass, Kevin D. Mullen, Arun Sanyal, et al.

Category: D. Digestive. Keywords: rifaximin, antibiotic, hepatic encephalopathy, liver disease, prevention, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 6 April 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.