Clinical

Rifaximin improves treatment of hepatic encephalopathy

Last Updated: 2013-08-20 14:40:16 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Adding rifaximin to lactulose improves the treatment of overt hepatic encephalopathy, researchers from India report.

Rifaximin has been shown to prevent hepatic encephalopathy and to decrease the risk of hospitalization. It's also been used on its own to treat acute hepatic encephalopathy, but it has not been studied extensively in combination with lactulose.

Dr. Barjesh Chander Sharma from GB Pant Hospital, New Delhi, India and colleagues compared rifaximin 1,200 mg per day plus lactulose to lactulose alone in a randomized trial of 120 patients with overt hepatic encephalopathy.

All patients also received other standard treatments, including antibiotics, electrolyte correction, and control of gastrointestinal bleeding.

Complete reversal of encephalopathy within 10 days occurred more often with combination therapy than with lactulose alone (76% vs 44%; p=0.004), the authors reported online July 23 in The American Journal of Gastroenterology.

The rifaximin/lactulose group also had significantly shorter hospital stays (mean, 5.8 vs 8.2 days; p=0.001) and significantly lower mortality (24% vs 49.1%; p<0.05).

The only independent predictors of nonresponse were baseline total leukocyte count and treatment with lactulose alone.

There were no serious side effects related to these treatments. Diarrhea requiring modification of lactulose treatment occurred in a similar number of patients in each group (eight with combination therapy, six with monotherapy).

"The limitations were that we did not monitor the serial arterial ammonia level and serum endotoxin level during therapy," the researchers note. "However, in routine practice, it is not monitored in the management of overt hepatic encephalopathy."

Dr. Lise Lotte Gluud from Copenhagen University Hospital Gentofte, Hellerup, Denmark, who has published extensively on treatments for hepatic encephalopathy but was not involved in the study, told Reuters Health by email, "My colleagues and I were very surprised at the results. The treatment duration in this trial is very short, and none of similar trials found such a strong effect. Also there is some evidence suggesting that rifaximin is more effective as monotherapy."

Dr. Gluud said that the evidence to support the use of lactulose plus rifaximin as the standard of care in this setting is not yet convincing.

"We need a thorough overview on different interventions for hepatic encephalopathy, including multicenter trials," Dr. Gluud concluded.

Dr. Sharma did not respond to a request for comments about this report.

SOURCE: http://bit.ly/1bQaWFe

Am J Gastroenterol 2013.