109 Long Term Efficacy and Survival in Patients Treated With the Gut-Selective Antibiotic Rifaximin (550 Mg Bid) for the Maintenance of Remission From Overt Hepatic Encephalopathy

Lack of Clostridium difficile Infection in Patients Treated With Rifaximin for Hepatic Encephalopathy

“…These results support those of the phase 3, 6-month doubleblind trial and the open-label, long-term extension trial that demonstrated the efficacy of rifaximin in reducing the risk of recurrence of HE in patients in HE remission for up to 21 months. 23,24 In the phase 3 trial, only 2 of 140 patients (1%) who received rifaximin developed CDI during the treatment. Both patients, who fully recovered from CDI after treatment, had several risk factors for CDI, including advanced age, recent hospitalizations with multiple courses of antibiotic therapy, and the use of pantoprazole, a proton-pump inhibitor.…”

“…11,23 Data from an ongoing long-term, open-label safety analysis of rifaximin for reducing the risk of overt HE recurrence (N = 336; 114 patients treated for Z1 y) indicate that long-term rifaximin treatment has a safety profile similar to that described for the 6-month randomized controlled trial. 23,24 Given this information, rifaximin appears to be a safe and well-tolerated antibiotic.…”

Clostridium difficile Infection in Hospitalized Cirrhotic Patients with Hepatic Encephalopathy

“…It is recommended by current J Gastrointestin Liver Dis, December 2015 Vol. 24 No 4: 423-428 guidelines as an effective add-on therapy to lactulose for prevention of overt HE recurrence [1]; several studies found that rifaximin was equally effective as lactulose for either HE treatment or prevention [15][16][17][18][19][20].…”

The effect of sub-inhibitory concentrations of rifaximin on urease production and on other virulence factors expressed by Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa and Staphylococcus aureus

“…Table 3 Inhibition of pigment production in P. aeruginosa and in C. violaceum exposed to rifaximin and ciprofloxacin at the indicated sub-MIC concentrations and has beneficial effects on patients affected by hepatic encephalopathy treated for long periods of time (from six to over 24 months) also reducing the risk of recurrence of this pathology and related hospitalisations. 12,18 Rifaximin should have a double advantage in comparison with other topically used drugs: the antibacterial activity against urease-producing bacteria reduces their proliferation and number in the gastrointestinal tract and interferes with urease synthesis which deprives these pathogens of their major virulence factor. This should explain the beneficial effects of rifaximin reported in the above-mentioned studies.…”

“…In another recent study, in fact, it was demonstrated that rifaximin therapy significantly reduced the risk of overt hepatic encephalopathy recurrence and related hospitalizations during long periods of time (from six to over 24 months) in patients with cirrhosis and histories of recurrent overt hepatic encephalopathy. 12,18 Since it is necessary to assume that, given enough antibiotic and time, resistance will appear against any drug, the efficacy of rifaximin in the management of the above pathologies cannot be solely attributed to the antibacterial activity of the drug. When microorganisms are exposed to this drug for long periods of time, they might in many circumstances develop resistance.…”