Analysis of Hospitalizations Comparing Rifaximin Versus Lactulose in the Management of Hepatic Encephalopathy

Neff, Guy; Kemmer, Nyingi; Zacharias, Victoria; Kaiser, Tiffany E.; Duncan, Christopher W.; McHenry, R.; Jonas, Mark E.; Novick, David M.; Williamson, C.; Hess, Krista L.; Thomas, Mark J.; Buell, Joseph F.

doi:10.1016/j.transproceed.2006.10.107

Cited by 57 publications

(47 citation statements)

References 15 publications

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“…6,21,22 New nonabsorbable antibiotics specifically designed for SID, such as rifaximin, should be analyzed in this population, mostly because of the promising results of this drug in the prevention of encephalopathy in patients with cirrhosis. 26,27 Finally, preliminary results suggest that nonantibiotic SID strategies, such as the use of probiotics or prebiotics, could be useful in the prevention of EBIs in LTRs. 28 This study has some limitations that deserve specific consideration.…”

Section: Discussionmentioning

confidence: 99%

Selective intestinal decontamination with fluoroquinolones for the prevention of early bacterial infections after liver transplantation

et al. 2011

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The role of selective intestinal decontamination with fluoroquinolones (FQ-SID) in the prevention of early bacterial infections (EBIs) in liver transplant recipients (LTRs) is unknown. We used the online database of the Spanish Network of Infection in Transplantation/ Spanish Network for Research in Infectious Diseases, which prospectively analyzed 1010 LTRs from 12 Spanish hospitals from September 2003 to February 2005. We compared the incidence and etiology of EBIs (30 days after transplantation) in 415 LTRs from 4 centers that used FQ-SID (>7 days) and in 595 LTRs from 8 hospitals that did not use FQ-SID. A multivariate logistic regression analysis (including an adjustment for the transplant center factor) was performed to evaluate the potential protective factor of FQ-SID in the development of EBIs. We reported 266 EBI episodes in 252 LTRs (incidence ¼ 24.9%). There were no differences in the incidence of EBIs between patients in the FQ-SID group and patients not in the FQ-SID group [109/415 (26.3%) versus 143/595 (24%), P ¼ 0.9]. Although LTRs who received FQ-SID had a lower incidence of infections due to enteric bacteria (2.7% versus 6.5%, P ¼ 0.007) and a higher incidence of infections due to nonfermenting gram-negative bacilli (6.6% versus 2.6%, P ¼ 0.004), these findings could not be confirmed after an adjustment by the center factor in the multivariate models. We found no significant differences in the incidence of enterococcal infections (3.4% with FQ-SID versus 3.9% without FQ-SID, P ¼ 0.5). Multivariate analysis did not confirm any protective effect of FQ-SID against the development of EBIs by enteric bacteria. In conclusion, FQ-SID does not reduce the incidence of EBIs in LTRs and could be withheld from this group of patients. Liver Transpl 17:896-904,

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Section: Discussionmentioning

confidence: 99%

Selective intestinal decontamination with fluoroquinolones for the prevention of early bacterial infections after liver transplantation

et al. 2011

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“…Moreover, hepatic encephalopathy imposes a formidable burden on families, because patients are incapable of selfcare. 1,4,[55][56][57] Neff et al 55 performed a retrospective review in which they discussed the cost comparison between standard therapy of lactulose and non-nonabsorbable therapy in liver transplanted patients presenting with stage II hepatic encephalopathy. In this study, the importance of cost-analysis as opposed to drug price when analyzing health care expenditures is reasserted.…”

Section: Influence Of Rifaximin On Economic Burden Of Hepatic Encephamentioning

confidence: 99%

Rifaximin Treatment in Hepatic Encephalopathy

Sharma

Sharma²

2010

N Engl J Med

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Hepatic encephalopathy is a challenging complication in patients with advanced liver disease. It can be defined as a neuropsychiatric syndrome caused by portosystemic venous shunting, ranging from minimal to overt hepatic encephalopathy or coma. Its pathophysiology is still unclear, although increased levels of ammonia play a key role. Diagnosis of hepatic encephalopathy is currently based on specific tests evaluating the neuropsychiatric state of patients and their quality of life; the severity of hepatic encephalopathy is measured by the West Haven criteria. Treatment of hepatic encephalopathy consists of pharmacological and corrective measures, as well as nutritional interventions. Rifaximin received approval for the treatment of hepatic encephalopathy in 2010 because of its few side effects and pharmacological benefits. The aim of this work is to review the use and efficacy of rifaximin both in acute and long-term management of hepatic encephalopathy. Treatment of overt hepatic encephalopathy involves management of the acute episode as well as maintenance of remission in those patients who have previously experienced an episode, in order to improve their quality of life. The positive effect of rifaximin in reducing health care costs is also discussed.

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“…An American study showed that although the monthly drug cost of rifaximin was higher than that for lactulose ($620 per month vs $50 per month), those receiving rifaximin required fewer hospitalisations over an observation period of one year and those who were admitted had a shorter average length of stay. 4 Consequently, the total cost of therapy per patient per year was lower with rifaximin than with lactulose ($7,958 vs $13,285).…”

Section: Discussionmentioning

confidence: 99%