Hospitalizations During the Use of Rifaximin Versus Lactulose for the Treatment of Hepatic Encephalopathy

Overview

Journal Dig Dis Sci

Specialty Gastroenterology

Date 2007 Jan 25

PMID 17245628

Citations 50

Authors

Carroll B Leevy

James A Phillips

Affiliations

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Abstract

We sought to compare frequency and duration of hepatic encephalopathy-related hospitalizations during rifaximin versus lactulose treatment. Hospitalizations, clinical efficacy data, and adverse events obtained from charts of 145 patients with hepatic encephalopathy who received lactulose (30 cc twice daily) for > or = 6 months and then rifaximin (400 mg 3 times a day) for > or = 6 months compared last 6 months on lactulose (lactulose period) to first 6 months on rifaximin (rifaximin period). Fewer hospitalizations (0.5 versus 1.6; P < .001), fewer days hospitalized (2.5 versus 7.3; P < .001), fewer total weeks hospitalized (0.4 versus 1.8; P < .001), and lower hospitalization charges per patient ($14,222 versus $56,635) were reported during the rifaximin period. More patients had asterixis, diarrhea, flatulence, and abdominal pain during the lactulose period (P < .001). Treatment of hepatic encephalopathy with rifaximin was associated with lower hospitalization frequency and duration, lower hospital charges, better clinical status, and fewer adverse events.

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References

Nolte W, Wiltfang J, Schindler C, Munke H, Unterberg K, Zumhasch U . Portosystemic hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with cirrhosis: clinical, laboratory, psychometric, and electroencephalographic investigations. Hepatology. 1998; 28(5):1215-25. DOI: 10.1002/hep.510280508. View

Williams R, Bass N . Rifaximin, a nonabsorbed oral antibiotic, in the treatment of hepatic encephalopathy: antimicrobial activity, efficacy, and safety. Rev Gastroenterol Disord. 2005; 5 Suppl 1:S10-8. View

Hartmann I, Groeneweg M, Quero J, Beijeman S, de Man R, Hop W . The prognostic significance of subclinical hepatic encephalopathy. Am J Gastroenterol. 2000; 95(8):2029-34. DOI: 10.1111/j.1572-0241.2000.02265.x. View

Blei A . Diagnosis and treatment of hepatic encephalopathy. Baillieres Best Pract Res Clin Gastroenterol. 2001; 14(6):959-74. DOI: 10.1053/bega.2000.0141. View

Das A, Dhiman R, Saraswat V, Verma M, Naik S . Prevalence and natural history of subclinical hepatic encephalopathy in cirrhosis. J Gastroenterol Hepatol. 2001; 16(5):531-5. DOI: 10.1046/j.1440-1746.2001.02487.x. View

VLAHCEVIC Z . Hepatic encephalopathy. Metabolic consequence of cirrhosis often is reversible. Postgrad Med. 2001; 109(2):52-4, 57-60, 63-5 passim. DOI: 10.3810/pgm.2001.02.850. View

Morgan M . The treatment of chronic hepatic encephalopathy. Hepatogastroenterology. 1991; 38(5):377-87. View

Huang D, DuPont H . Rifaximin--a novel antimicrobial for enteric infections. J Infect. 2005; 50(2):97-106. DOI: 10.1016/j.jinf.2004.05.019. View

Maddrey W . Role of antibiotics in the management of hepatic encephalopathy. Rev Gastroenterol Disord. 2005; 5 Suppl 1:S3-9. View

10.

Boyer T, Haskal Z . The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension. Hepatology. 2005; 41(2):386-400. DOI: 10.1002/hep.20559. View

11.

Steffen R, Sack D, Riopel L, Jiang Z, Sturchler M, Ericsson C . Therapy of travelers' diarrhea with rifaximin on various continents. Am J Gastroenterol. 2003; 98(5):1073-8. DOI: 10.1111/j.1572-0241.2003.07283.x. View

12.

Riordan S, Williams R . Treatment of hepatic encephalopathy. N Engl J Med. 1997; 337(7):473-9. DOI: 10.1056/NEJM199708143370707. View

13.

Amodio P, Del Piccolo F, Petteno E, Mapelli D, Angeli P, Iemmolo R . Prevalence and prognostic value of quantified electroencephalogram (EEG) alterations in cirrhotic patients. J Hepatol. 2001; 35(1):37-45. DOI: 10.1016/s0168-8278(01)00129-5. View

14.

Pakyz A . Rifaximin: a new treatment for travelers' diarrhea. Ann Pharmacother. 2004; 39(2):284-9. DOI: 10.1345/aph.1E407. View

15.

Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei A . Hepatic encephalopathy--definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002; 35(3):716-21. DOI: 10.1053/jhep.2002.31250. View

16.

Miura M, Nomoto Y, Sakai H . Short term effect of lactulose therapy in patients with chronic renal failure. Tokai J Exp Clin Med. 1989; 14(1):29-34. View