Rifaximin Treatment in Hepatic Encephalopathy

Abstract

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.

Rifaximin microbial resistance and its efficacy and safety as a secondary prophylaxis of hepatic encephalopathy in patients with hepatitis C virus‐related cirrhosis

“…This study also showed that the rate of adverse effects with longterm use of rifaximin is low which appeared to be similar to previously reported adverse effects of rifaximin in other studies, 23,26,27 although more than 50% of patients in these studies were cirrhotic because of alcohol abuse.…”

“…Although a growing number of studies have proved the efficacy of rifaximin in HE treatment in hepatic patients, 19,23,24,25,26,27,28,29 these studies enrolled patients mainly with alcohol-related cirrhosis and none of them addresses those with HCV-related cirrhosis.…”

Management of Hepatic Encephalopathy Associated with Advanced Liver Disease

“… Rifaximin is the most used antibiotic in HE because it shows the best efficacy and safety profile, acting on the functionality of the microbiota. It is highly effective in secondary prevention, showing that when added to non-absorbable disaccharides, it prevents a third episode of encephalopathy (hazard ratio = 0.42; 95% confidence interval 0.28–0.64) [ 56 , 57 ]. The combination of lactulose plus rifaximin was more effective than lactulose alone to treat episodic overt HE and reduce mortality due to a reduction in sepsis-related deaths in a trial [ 57 ].…”