Comparison of Rifaximin and Lactulose for the Treatment of Hepatic Encephalopathy: A Prospective Randomized Study

Abstract

Rifaximin has been reported to be effective for the treatment of hepatic encephalopathy (HE) in Europe. However, it is unknown whether Rifaximin is effective for the treatment of HE in Koreans, therefore we conducted a open-label prospective randomized study to evaluate the efficacy of rifaximin versus lactulose in Korean patients. Fifty-four patients with liver cirrhosis and hepatic encephalopathy were enrolled. Thirty-two patients were randomized to receive rifaximin and 22 to receive lactulose both over a 7-day periods. Before and at the end of treatment, gradation of blood ammonia, flapping tremor, mental status, number connection test (NCT) were performed and estimation of HE indexes determined. Both rifaximin and lactulose were effective in the majority of patients (84.4% and 95.4%, respectively, p=0.315). Blood NH3, flapping tremor, mental status, and NCT was significantly improved by rifaximin and lactulose, and the posttreatment levels of these measures were similar for the rifaximin and lactulose-treated groups, as was the HE index (rifaximin group (10.0→4.2, p=0.000); lactulose group (11.3→5.0, p=0.000)). One patient treated with rifaximin complained of abdominal pain, which was easily controlled. There was no episode of renal function impairment in either treatment group. Rifaximin proved to be as safe and as effective as lactulose for the treatment of Korean patients with hepatic encephalopathy.

Role of Rifaximin for the Treatment of Hepatic Encephalopathy in Chronic Liver Disease

“…There was significant difference of mean of PSE index in both groups. This result differ with other study conducted by Paik et al 31 where PSE index were similarly decreased in both group (p = <0.001).…”

“…But, this result differ with other study conducted by Paik et al showed the mean HE grade was similarly decreased within the study group (p=<0.001). 31 At the end of treatment, the mean PSE index was also more decreased in group A (11.71'!3.35, p = <0.05) than in group B (11.76'!6.10, p = <0.05). There was significant difference of mean of PSE index in both groups.…”

“…Study conducted by Paik et al also showed no significant difference of CTP score mean between two groups (p = 0.404, 0.505 respectively). 31 There was significant difference of means of duration of hospital stay between two groups (p=0.008). This results support two retrospective review studies, where rifaximin and lactulose reduced risk and duration of hospitalization.…”

“…Another study conducted by Paik et al also showed no significant age and gender difference. 31 At enrollment there was no significant difference of means of mean PSE index between two groups. At the end of treatment, there was significant difference of means of PSE index between two group (p= 0.017 At enrollment, there was no significant difference of HE grade between two groups (p=0.772).…”

Comparison of Rifaximin, Lactulose With Rifaximin, Lactulose, Branched Chain Aminoacids (Bcaa) in Grade 1 to Grade 3 of Hepatic Encephalopathy- Non Randomized Controlled Trial Study

“…The side effects of non-absorbable disaccharides include abdominal pain, flatulence, and severe diarrhoea, which may lead to the cessation of therapy. 8 A few patients dislike the sweet taste of the preparations, so dilution with water or administering the preparation with fruit juice can mask the taste. 9,10,11 Rifaximin is a semi-synthetic, gut-selective, and nonabsorbable oral antibiotic, derived from rifamycin and a structural analogue of rifampin.…”