Efficacy of rifaximin in the different clinical scenarios of hepatic encephalopathy

Coronel-Castillo, Carlos E.; Contreras-Carmona, Jocelyn; Frati-Munari, A C; Uribe, Misael; Méndez-Sánchez, Nahúm

doi:10.1016/j.rgmxen.2019.09.003

Cited by 8 publications

(5 citation statements)

References 87 publications

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“…Several studies show that rifaximin prevents development of HE, but the mechanism by which this occurs is not clear ( Bass Nathan et al., 2010 ; Ito et al., 2019 ; Coronel-Castillo et al., 2020 ; Labenz et al., 2020 ; Lv et al., 2020 ). Although rifaximin exerts antibacterial effects against a wide range of Gram-positive and Gram-negative bacteria in vitro , our study found that rifaximin administration did not affect the stability of the gut microbiota, and that the antibacterial effect of rifaximin in the intestine was not significant.…”

Section: Discussionmentioning

confidence: 99%

Rifaximin Modulates the Gut Microbiota to Prevent Hepatic Encephalopathy in Liver Cirrhosis Without Impacting the Resistome

Zhou

Xiao

et al. 2022

Front. Cell. Infect. Microbiol.

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The gut microbiota has an important role in the pathogenesis of hepatic encephalopathy(HE). Rifaximin, an intestinal non-absorbable antibacterial agent, is effective in the treatment of HE. However, whether long-term prophylactic use induces antibacterial resistance and its mechanism for treating HE remains unclear. This prospective study assessed the impact of 12 weeks rifaximin administration on the gut microbiota and resistome in cirrhotic patients. Fecal sampling was conducted 1 day before the first rifaximin administration and at Weeks 1, 2, 4, 6, 8, 10, 12 of the study. Thirty cirrhotic patients who were in remission from recurrent HE was enrolled to receive rifaximin (400mg TID for 12 weeks). Rifaximin improved hyperammonemia and cognitive function in the 21 patients who completed rifaximin treatment. The dynamic observations showed the gut microbiota diversity, composition and the number of resistance genes, plasmids, insertion sequences did not change significantly during the period(P>0.05). Metabolic pathways such as aromatic amino acids, tryptophan synthesis, urea cycle, and LPS synthesis reduced. No new antimicrobial resistance genes was emergenced. However, the number of aminoglycosides, rifamycin and phenolic resistance genes increased, whereas tetracycline, fosfomycin and cephamycin decreased (P<0.05). Changes in the abundance of E. coli, K. pneumoniae, and B. longum strains correlated with changes of resistance genes. Prophylactic use of rifaximin for 12 weeks improved hyperammonemia and neurophysiological function, maintained gut microbiota diversity, composition and did not change the overall resistome. Rifaximin altered expression of HE-related metabolic pathways. All of these effects could play a key role in preventing HE. Clinical Trial Registration: ChiCTR1900022234 (registered at the Chinese Clinical Trial Registry).

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Section: Discussionmentioning

confidence: 99%

Rifaximin Modulates the Gut Microbiota to Prevent Hepatic Encephalopathy in Liver Cirrhosis Without Impacting the Resistome

Zhou

Xiao

et al. 2022

Front. Cell. Infect. Microbiol.

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“…Therefore the treatment therapies in HE rely on reducing the neurotoxin and nitrogenous load from the gastro-intestinal track 11 . Rifaximin is an oral antimicrobial which is minimally absorbed from the gut and has a broad spectrum of action against anaerobes, gram-negative and gram-positive enteric bacteria with low risk of resistance 12 . The objective of present study was to find out the frequency of recurrence of hepatic encephalopathy in patients of chronic liver disease treated with rifixamin, so that appropriate adjustment to therapy may be made in such patients to reduce disease burden, morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Recurrence of Hepatic Encephalopathy in Patients of Chronic Liver Disease Treated With Rifaximin

Arif¹,

Butt²,

Ali³

et al. 2022

PJMHS

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Aim: To determine the frequency of recurrence of hepatic encephalopathy in patients treated with Rifaximin. Study design: Observational cross-sectional study. Setting & duration: Department of Medicine, Services institute of Medical Sciences Lahore for duration of 12 months. Methodology: Hepatic encephalopathy was diagnosed using West-Haven classification in patients of chronic liver disease. Recurrence was considered if a new episode of hepatic encephalopathy occurred within 3 months after initiation of treatment. A total 120 patients of chronic liver disease having had an episode of recent hepatic encephalopathy within the last 3 months, of both genders, above 20 years of age with hepatic encephalopathy were included in the study. The patients were followed for 3 months after initiation of therapy and any episode of recurrence of hepatic encephalopathy was recorded. Results: Mean age was 51.5±12.2 years and 52.3±12.8 years respectively in Rifaximin and Placebo groups. Fourteen (23.3%) patients in Rifaximin group and 17(28.3%) in placebo group were younger than 40 years of age. Thirty-three (55%) patients in Rifaximin group were male versus 29(48.3%) patients in Placebo group. Fifteen (25%) patients in Rifaximin Group developed hepatic encephalopathy by 3 months of follow up as compared to 31(51.7%) patients in Placebo Group Conclusion: Frequency of recurrence of hepatic encephalopathy is significantly lower in Rifaximin treated patients. Keywords: Hepatic Encephalopathy, Recurrence, Rifaximin.

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“…These symptoms are mainly a result of elevated levels of ammonia. Rifaximin was able to reduce levels of ammonia-producing intestinal bacteria without decreasing GMB diversity, while also significantly reducing hospital stay, mortality rate, and improving psychometric test performance in patients with mild and severe hepatic encephalopathy compared to other treatments [139] . These observations support alternate uses for rifaximin which may be related to beneficial changes in microbiota and SCFAs, including its indication for CNS-related disorders.…”

Section: Antibiotics: Non-absorbable "Eubiotic" Rifaximinmentioning

confidence: 91%

Microbiome meets microglia in neuroinflammation and neurological disorders

Reyes¹,

Zhang²,

Gao³

et al. 2020

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One of the emerging hot topics in biosciences is the intriguing link between gut microbial communities and its influences outside the gastrointestinal tract, such as the central nervous system (CNS), including its cognitive activities and immune responses. Beyond its neuroprotective properties, microglia are also critical for neuronal synaptic pruning and neural remodeling during CNS development. Prolonged microglia activation and neuroinflammation are considered key contributors to neurological disorders. In this regard, it is becoming increasingly important to consider the potential influences underlying the crosstalk between the intestinal microbiota ecosystem and host when determining biomarkers of disease and treatment efficacy. The commensal microbiota is critical for immune development and continuous function through the recognition of bacteriaproduced and regulated metabolites. In cases of microbial dysbiosis and microglial dysfunction, chronic neuroinflammation may persist, leading to the propagation of neurological disorders. To address potential mechanisms, this review focuses on the microbiota-gut-brain axis as it relates to communication pathways that have been linked to aberrant CNS immune activity and pathology. We also address anti-inflammatory and neuroprotective mediators which may counteract these detrimental activities. Finally, we explore the potential benefits of current and novel microbiome-targeted approaches to treat neuroinflammation and consequential neurological disease.

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Efficacy of rifaximin in the different clinical scenarios of hepatic encephalopathy

Cited by 8 publications

References 87 publications

Rifaximin Modulates the Gut Microbiota to Prevent Hepatic Encephalopathy in Liver Cirrhosis Without Impacting the Resistome

Rifaximin Modulates the Gut Microbiota to Prevent Hepatic Encephalopathy in Liver Cirrhosis Without Impacting the Resistome

Frequency of Recurrence of Hepatic Encephalopathy in Patients of Chronic Liver Disease Treated With Rifaximin

Microbiome meets microglia in neuroinflammation and neurological disorders

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