Low-dose rifaximin prevents complications and improves survival in patients with decompensated liver cirrhosis

Zeng, Xin; Sheng, Xia; Wang, Pei-Qin; Xin, Haiguang; Guo, Yuxin; Lin, Yong; Zhong, Jiawei; He, Cheng-Zhi; Yin, Jie; Liu, Taotao; Ma, Wei-Juan; Xiao, Xiao; Shi, Pei-Mei; Yuan, Zong-Li; Yang, Ling; Ma, Xiong; Xu, Jianming; Shen, Xin; Chen, Yang; Zhu, Xuan; Lv, Nonghua; Xie, Wei‐Fen

doi:10.1007/s12072-020-10117-y

Cited by 24 publications

(26 citation statements)

References 28 publications

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“…15 Long-term administration of rifaximin at 800 mg/day reduced the overall complications and prolonged survival in decompensated cirrhotic patients. 16 In this study, we discovered that low-dose rifaximin (800 mg/day) had therapeutic effectiveness comparable to high-dose rifaximin (1,200 mg/day) on CHE reversal and HRQOL improvement in patient with cirrhosis after 8 weeks of treatment. The lower dosage of rifaximin (800 mg/day) would probably be effective for the treatment of MHE in Chinese liver cirrhosis patients.…”

Section: Discussionmentioning

confidence: 79%

“…15 More recently, we reported that treatment with low-dose rifaximin (800 mg/day) for 6 months significantly decreased overall complications and prolonged the survival of patients with decompensated liver cirrhosis. 16 The data suggest 800 mg/ day of rifaximin might be sufficient for the treatment of HE, at least in Chinese patients. Accordingly, we conducted this prospective randomized controlled study to investigate the efficacy and safety of low-dose (800 mg/day) and high-dose (1,200 mg/day) rifaximin for the treatment of CHE.…”

Section: Introductionmentioning

confidence: 96%

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Effects of Low-dose and High-dose Rifaximin in the Treatment of Covert Hepatic Encephalopathy

Tan¹,

Wang²,

Shi³

et al. 2022

J Clin Transl Hepatol

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Background and Aims: Rifaximin is effective in preventing and treating hepatic encephalopathy (HE). This study aimed to investigate the efficacy and safety of different dosages of rifaximin in the treatment of cirrhotic patients with covert HE (CHE). Methods: In this single-center, randomized, controlled, open-label study, CHE was diagnosed using a combination of the psychometric HE score and the EncephalApp Stroop test. Cirrhotic patients with CHE were recruited and randomly assigned to low-dose rifaximin 800 mg/day, highdose rifaximin (1,200 mg/day), and control groups, and were treated for 8 weeks. The sickness impact profile (SIP) scale was used to evaluate the health-related quality of life (HRQOL) of patients. Forty patients were included in the study, 12 were assigned to the low-dose group, 14 to the high-dose group, and 14 patients to the control group. Results: The percentage of patients with CHE reversal was significantly higher in both the low-dose (41.67%, 5/12) and high-dose (57.14%, 8/14) groups than in the control group (7.14%, 1/14) at 8 weeks (p=0.037 and p=0.005, respectively). In addition, both doses of rifaximin resulted in significant improvement of the total SIP score compared with the control group. There were no significant differences in the CHE reversal rate, total SIP score improvement, and incidence of adverse event between the low-dose and highdose groups (p>0.05). Conclusions: Low-dose rifaximin reverses CHE and improves HRQOL in cirrhotic patients with comparable effects and safety to high-dose rifaximin.

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Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 96%

Effects of Low-dose and High-dose Rifaximin in the Treatment of Covert Hepatic Encephalopathy

Tan¹,

Wang²,

Shi³

et al. 2022

J Clin Transl Hepatol

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“…A recent investigation has reported that rifaximin significantly decreases the occurrence of overall complications in patients with advanced stages of cirrhosis, leading to prolonged survival ( 23 ). Rifaximin may play a role in gut barrier repair, which may be the mechanism by which it ameliorates bacterial translocation and systemic endotoxemia in cirrhosis ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Elevation of enterococcus-specific antibodies associated with bacterial translocation is predictive of survival rate in chronic liver disease

et al. 2022

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Introduction/purposeThe gut-liver axis contributes to disease progression, a rise in infection rate, organ failure and a poor overall outcome in chronic liver diseases (CLD). Monitoring of the gut-liver axis is critical in understanding disease status, but biomarkers have not been elucidated. The aim of this study is to determine the level of serum antibodies against Enterococcus (E.) faecalis in evaluating patients with CLD, including those treated with rifaximin (a minimally absorbed antibiotic), and in patients with alcohol-associated liver disease (ALD).Materials and methodsWe enrolled 109 CLD patients (cohort 1), 30 hepatic encephalopathy patients treated with rifaximin (cohort 2), 53 inpatients with ALD undergoing alcohol cessation (cohort 3) and 33 healthy subjects. To assess the consequences of E. faecalis translocation, we developed an assay for the detection of a serum antibody against E. faecalis capsular polysaccharide (E.CPS).ResultsSerum E.CPS antibody titer was elevated only in those patients with advanced CLD and ALD. The E.CPS antibody titer was an independent prognostic factor (p < 0.05), while Mac-2 binding protein and albumin-bilirubin score were not independent predictors of survival. The improvement of predictive model in integrated factors was significant [continuous net reclassification index (value 0.699, p < 0.05) and integrated discrimination improvement (value 0.164, p = 0.051)]. Furthermore, rifaximin treatment led to a decrease of serum E.CPS antibody titer resulting in a significantly longer overall rate of survival.ConclusionThe E.CPS antibody titer appears to be a strong predictor of survival in CLD patients. Serum E.CPS levels decrease in CLD patients receiving rifaximin, and may be associated with an overall improvement in rate of survival.

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“…In the present study, kanamycin/rifaximin treatment with lactulose tended to decrease the incidence of AKI compared to treatment with lactulose alone in cases with hepatic encephalopathy (P = 0.06). A leaky gut increases the risk of SBP in patients with ascites, and kanamycin/rifaximin has been reported to reduce SBP in such cases 26 In patients receiving treatment for hepatic encephalopathy, Zeng et al 27 reported that kanamycin/ rifaximin protected against ascites exacerbation (P < 0.001) and gastric variceal bleeding (P = 0.03). PPI treatment has been reported to have negative effects in patients with cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Risk and protective factors of acute kidney injury in decompensated cirrhotic patients with ascites on tolvaptan

et al. 2021

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Background and AimAcute kidney injury (AKI) is a life‐threatening complication of liver cirrhosis. Here, we evaluated the risk factors and characteristics of AKI in cirrhosis.Patients/MethodsThis was a single‐center retrospective study. A total of 199 Japanese patients with decompensated liver cirrhosis (104 men, median age 61 years) were enrolled and received tolvaptan orally. Survival rates and new onset of AKI were monitored, and risk factors were evaluated.ResultsForty‐six patients (23.1%) suffered an AKI complication and exhibited significantly poorer survival (P < 0.01). The rates of hepatic encephalopathy (P < 0.01) and chronic kidney disease (CKD; P = 0.02) were significantly increased in patients with AKI. The rate of proton pump inhibitor (PPI)/H2 blocker treatment (P = 0.04) was significantly lower, whereas that of ascites drainage was significantly higher in the AKI cases (P < 0.01). The AKI risk was significantly increased in patients with hepatic encephalopathy (HR 4.18, 95% CI 1.618–10.771). In contrast, the incidence of AKI was significantly lower in patients with a higher serum albumin level (HR 0.36, 95% CI 0.142–0.914, P = 0.03). Treatment with PPI/H2 blockers (HR 0.30, 95% CI 0.126–0.711, P < 0.01) or kanamycin/rifaximin (HR 0.26, 95% CI 0.075–0.929, P = 0.04) was significantly associated with a reduced risk of AKI development.ConclusionsAKI incidence was increased in patients with decreased liver function and was associated with poor survival. PPI/H2 blocker or kanamycin/rifaximin treatment may reduce the risk of AKI.

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Low-dose rifaximin prevents complications and improves survival in patients with decompensated liver cirrhosis

Cited by 24 publications

References 28 publications

Effects of Low-dose and High-dose Rifaximin in the Treatment of Covert Hepatic Encephalopathy

Effects of Low-dose and High-dose Rifaximin in the Treatment of Covert Hepatic Encephalopathy

Elevation of enterococcus-specific antibodies associated with bacterial translocation is predictive of survival rate in chronic liver disease

Risk and protective factors of acute kidney injury in decompensated cirrhotic patients with ascites on tolvaptan

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