Lack of Clostridium difficile Infection in Patients Treated With Rifaximin for Hepatic Encephalopathy

Neff, Guy; Jones, Michael; Jonas, Mark E.; Ravinuthala, Ravi; Novick, David M.; Kaiser, Tiffany E.; Kemmer, Nyingi

doi:10.1097/mcg.0b013e318276be13

Cited by 30 publications

(19 citation statements)

References 26 publications

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“…Garey y cols., en el 2011, en vista de que en series no controladas se había mostrado disminución de las recurrencias con el uso de rifaximina siguiendo terapias habituales, diseñó un ECR doble ciego comparando placebo vs rifaximina al término de una terapia estándar con vancomicina mostrando que las recurrencias con placebo fueron 49 vs 21% con rifaximina 141 . Reportes de casos, revisiones bibliográficas y estudios no controlados 129,[142][143][144][145][146][147][148] coinciden en la utilidad en el uso de rifaximina en recurrencias. La dosis utilizada en los estudios es de 400 mg c/8 h vía oral por 28 días siguiendo a un curso habitual de vancomicina oral.…”

Section: ¿Es úTil El Uso De Rifaximina?unclassified

Consenso chileno de prevención, diagnóstico y tratamiento de la diarrea asociada a Clostridium difficile

Hernández-Rocha

Pidal

Ajenjo

et al. 2016

Rev. chil. infectol.

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Section: ¿Es úTil El Uso De Rifaximina?unclassified

Consenso chileno de prevención, diagnóstico y tratamiento de la diarrea asociada a Clostridium difficile

Hernández-Rocha

Pidal

Ajenjo

et al. 2016

Rev. chil. infectol.

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“…No Clostridium difficile infections were observed in 211 patients receiving rifaximin for more than 6 months 48. Stable infection rates during long-term treatment with rifaximin were reported in a prospective cohort study of 392 patients 45.…”

Section: Safety Of Rifaximin Treatmentmentioning

confidence: 92%

Safety, efficacy, and patient acceptability of rifaximin for hepatic encephalopathy

Kimer¹,

Krag²,

Gluud³

2014

PPA

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Hepatic encephalopathy is a complex disease entity ranging from mild cognitive dysfunction to deep coma. Traditionally, treatment has focused on a reduction of ammonia through a reduced production, absorption, or clearance. Rifaximin is a nonabsorbable antibiotic, which reduces the production of ammonia by gut bacteria and, to some extent, other toxic derivatives from the gut. Clinical trials show that these effects improve episodes of hepatic encephalopathy. A large randomized trial found that rifaximin prevents recurrent episodes of hepatic encephalopathy. Most patients were treated concurrently with lactulose. Trials have varied greatly in design, outcomes, and duration of treatment regimes. Although a number of retrospective studies have indicated that long-term treatment with rifaximin is safe and possibly beneficial, high quality trials are needed to further clarify efficacy and safety of long-term treatment with rifaximin and evaluate effects of combination therapy with lactulose and branched-chain amino acids for patients with liver cirrhosis and hepatic encephalopathy.

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“…Norfloxacin is commonly used for outpatient prophylaxis of SBP [37], and quinolones are usually used in cirrhotics admitted with gastrointestinal bleeding [38,39]. By contrast, rifaximin does not seem to increase the risk of CDI [40]; what's more, rifaximin has proved to be effective in the treatment of recurrent CDI after LT [41]. Although the correlation with CDI is highest with certain antibiotics, it should be underlined that all antibiotics (including vancomycin and metronidazole) may be a causative factor for the development of CDI.…”

Section: Risk Factorsmentioning

confidence: 97%

Clostridium difficile infection in patients with liver disease: a review

Trifan

Stoica

Stanciu

et al. 2015

Eur J Clin Microbiol Infect Dis

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Over the past two decades, there has been a dramatic worldwide increase in both the incidence and severity of Clostridium difficile infection (CDI). Paralleling the increased incidence of CDI in the general population, there has been increased interest in CDI among patients with liver disease, particularly in those with liver cirrhosis and post liver transplantation. MEDLINE and several other electronic databases from January 1995 to December 2014 were searched in order to identify potentially relevant literature. Patients with cirrhosis and liver transplant recipients are at high risk for the development CDI because of antibiotics and proton pump inhibitors use, frequent and prolonged hospitalization, immunosuppressant therapy, and multiple comorbidities. Enzyme immunoassay to detect C. difficile toxins A and B in stool remains the most widely used test for CDI diagnosis, although, more recently, polymerase chain reaction (PCR)-based assays have become the preferred diagnostic test in many laboratories. Metronidazole and vancomycin, given orally, have proved to be effective in the treatment of CDI. Both cirrhotic patients and liver transplant recipients with CDI have longer length of hospital stay, increased mortality, and higher healthcare costs than those without CDI. A rapid diagnosis and adequate therapy of CDI are of paramount importance to improve liver disease patients' outcome. The aim of this review is to provide up-to-date information on the epidemiology, risk factors, pathogenesis, treatment, and outcomes in liver disease patients with CDI.

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Lack of Clostridium difficile Infection in Patients Treated With Rifaximin for Hepatic Encephalopathy

Abstract: This study demonstrates that treatment of HE with the safe, nonsystemic, gut-selective antibiotic rifaximin was not associated with the development of C. difficile infection.

Cited by 30 publications

References 26 publications

Consenso chileno de prevención, diagnóstico y tratamiento de la diarrea asociada a Clostridium difficile

Consenso chileno de prevención, diagnóstico y tratamiento de la diarrea asociada a Clostridium difficile

Safety, efficacy, and patient acceptability of rifaximin for hepatic encephalopathy

Clostridium difficile infection in patients with liver disease: a review

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