Rifaximin in the treatment of chronic hepatic encephalopathy; results of a multicenter study of efficacy and safety

Festi, Davide; Mazzella, Giuseppe; Orsini, Marco; Sottili, S.; Sangermano, A; Bassi, Silvia; Parini, P.; Ferrieri, A; Falcucci, Mariassunta; Grossi, L.; Marzio, L.; Roda, Enrico

doi:10.1016/s0011-393x(05)80681-2

Cited by 67 publications

(104 citation statements)

References 5 publications

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“…Nevertheless, all trials concluded equivalence from the lack of statistical significance. [30][31][32][33][34][35][36][37][38][39] It seems that the research was continuously building up on both insufficient evidence and inadequate methods. Our analyses indicate that antibiotics are statistically superior to non-absorbable disaccharides in improving hepatic encephalopathy and lowering blood ammonia concentrations.…”

Section: Discussionmentioning

confidence: 99%

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204 Nonabsorbable disaccharides for hepatic encephalopathy: A systematic review of randomised trials

Als‐Nielsen¹,

Gluud²

2004

Journal of Hepatology

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Section: Discussionmentioning

confidence: 99%

“…The antibiotics were neomycin, 5 6 30 ribostamycin, 31 vancomycin, 32 or rifaximin. [33][34][35][36][37][38][39] The median duration of treatment was 15 days (range 5-90 days). One trial assessed all outcomes 15 days after the end of treatment, 38 and one reported mortality 28 days after the end of treatment.…”

Section: Lactulose or Lactitol Versus Antibioticsmentioning

confidence: 99%

204 Nonabsorbable disaccharides for hepatic encephalopathy: A systematic review of randomised trials

Als‐Nielsen¹,

Gluud²

2004

Journal of Hepatology

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“…neomycin, paromomycin) in the treatment of HE. 27,[33][34][35] In a randomized, double-blind study, rifaximin 1200 mg/ day (n = 15) was compared with neomycin 3 g/day (n = 15) in 30 patients with cirrhosis and stage 1-3 HE. 33 After 21 days of treatment, neuropsychiatric symptoms and blood ammonia concentrations were significantly reduced vs. baseline in both groups; however, reduction in blood ammonia concentrations was significantly greater with rifaximin treatment vs. neomycin.…”

Section: Comparison Of Rifaximin With Other Antibioticsmentioning

confidence: 99%

Management of Overt Hepatic Encephalopathy

Sharma

2015

Journal of Clinical and Experimental Hepatology

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Hepatic encephalopathy (HE) is an important complication of cirrhosis with significant morbidity and mortality. Management of HE primarily involves avoidance of precipitating factors and administration of various ammonia-lowering therapies such as non-absorbable disaccharides, antimicrobial agents like rifaximin and L-ornithine L-aspartate. The non-absorbable disaccharides which include lactulose and lactitol are considered the first-line therapy for the treatment of HE and in primary and secondary prophylaxis of HE. Lactitol is comparable to lactulose in the treatment of HE with fewer side effects. Rifaximin is effective in treatment of HE and recent systemic reviews found it comparable to disaccharides and is effective in secondary prophylaxis of HE. H epatic encephalopathy (HE) is a complex neuropsychiatric syndrome, which may complicate acute, chronic liver failure or patients with portal-systemic shunting. It is characterized by changes in mental state including a wide range of neuropsychiatric symptoms ranging from minor signs of altered brain function to deep coma. 1,2 It is one of the commonest indications for admission in intensive care unit in patients with advanced cirrhosis. There were over 40 000 patients hospitalized in the United States alone for a primary diagnosis of HE, resulting in total charges of approximately $932 million. Data in other countries are lacking, hence it causes a huge burden financially to the patient and society. 3 The West Haven Criteria are most often used to grade HE, with scores ranging from I-IV (IV being coma). However, it is a challenge to diagnose patients with minimal hepatic encephalopathy (MHE) or grade 1 HE; so it might be practical to combine these entities and name them covert HE for clinical use and overt HE to patients with grade II to IV. 1,4,5 One of the major tenets of the pathophysiology of HE is hyperammonemia that results from an increased nitrogenous load from the gastrointestinal tract and reduced urea synthesis both due to portal-systemic shunting and decreased urea hepatic synthesis. Brain and skeletal muscle neither remove nor produce ammonium in normal conditions, but they are able to seize ammonium during hyperammonemia, releasing glutamine. Ammonia is produced both by bacterial degradation of amines, aminoacids, purines, and urea as well as enterocytic glutaminase activity that converts glutamine to glutamate and ammonia. 6,7 Astrocytes play an important role in the pathogenesis of HE with consequences for neuronal function. Astrocytes have the ability to eliminate ammonia by the synthesis of glutamine through amidation of glutamate by the enzyme glutamine synthetase Hyperammonemia leads to the accumulation of glutamine within astrocytes, which exerts an osmotic stress that causes astrocytes to take in water and swell. 8,9 This article reviewed the clinical impact, pathogenesis, and management of overt HE in patients with cirrhosis. Articles published between January 1960 and November 2013 were acquired through a MEDLINE search of different combi...

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“…Nei pazienti affetti da encefalopatia epatica, rifaximina ha dimostrato di essere meglio tollerata sia del lattulosio [14,39,41,42] che della neomicina [43]. Dopo il trattamento con rifaximina è stato spesso riportato un aumento dei livelli sierici di potassio [44,45] e di sodio [42,44], ma senza oltrepassare il limite di normalità.…”

Section: Tollerabilitàunclassified

“…Dopo il trattamento con rifaximina è stato spesso riportato un aumento dei livelli sierici di potassio [44,45] e di sodio [42,44], ma senza oltrepassare il limite di normalità.…”

Section: Tollerabilitàunclassified

Rifaximina nel trattamento della malattia diverticolare: potenziale terapeutico ed economico

Zaniolo

Eandi

2005

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INTRODUZIONEIl termine "malattia diverticolare" si riferisce a un concetto clinico usato a proposito di pazienti affetti da diverticolosi, sia sintomatica che asintomatica [1]. La diverticolosi del colon è una patologia acquisita caratterizzata dalla formazione di un gran numero di estroflessioni sacciformi della parete dell'intestino, localizzate più frequentemente nel colon sinistro, e in particolare nel colon sigmoideo.Queste erniazioni, dette appunto diverticoli, sono in genere causate da un'esagerata pressione all'interno del lume intestinale (diverticolo da pulsione) o, in casi limitati, da un'aderenza infiammatoria tra un organo cavo e linfonodi vicini (diverticolo da trazione). Si Rifaximina nel trattamento della malattia diverticolare: potenziale terapeutico ed economico Orietta Zaniolo*, Mario Eandi* ABSTRACTAntibiotics are commonly used to treat major inflammatory complications of diverticular disease, but apparently there is no rationale for the use of antibiotic therapy in uncomplicated disease, where an inflammatory component is by definition excluded. Some observations suggest a possible role of gut microflora in determining some symptoms related to diverticular disease: bacterial overgrowth, amplifying gas production and bacterial degradation of fibres, could determine bloating, pain and high fecal density. Therefore a beneficial antibiotic action on diverticular disease symptoms can be hypothesized. In this paper pharmacokinetic, pharmacodinamic and therapeutic potential of an intestinal antibiotic, rifaximin, are reviewed. Rifaximin is a rifamycin derivative which acts by inhibiting bacterial ribonucleic acid (RNA) synthesis. It is virtually unabsorbed after oral administration and in vitro data indicate it to possess a broad spectrum of action; bacterial resistance during exposure to rifaximin has been reported but its clinical importance remains to be fully defined. The results of placebo-controlled clinical trials show that cyclic administration of rifaximin is more effective in reducing symptoms and in preventing complications than fibre supplementation alone; the drug appears to be well tolerated and safe. We consider the clinical implications and economical impact of diverticulosis on the Italian National Health System and the patient, with a particular attention on the cost of hospitalization, surgery and global management of diverticulitis and other common disease complications. The hypothetic savings correlated to the reduction of complications incidence, attainable with rifaximin use have been calculated and the comparison between the different acquisition costs of the drug frequently used to treat the diverticular disease is provided. Finally we reviewed some quality of life trials in which the psychological and sociological influence of the disease symptoms and treatments on the patient are assessed.Keywords: diverticular disease, rifaximin, antibiotics, economical impact Farmeconomia e percorsi terapeutici 2005; 6 (1): 5-20 PROFILO *Farmacologia Clinica, Università di Torino rit...

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Rifaximin in the treatment of chronic hepatic encephalopathy; results of a multicenter study of efficacy and safety

Cited by 67 publications

References 5 publications

204 Nonabsorbable disaccharides for hepatic encephalopathy: A systematic review of randomised trials

204 Nonabsorbable disaccharides for hepatic encephalopathy: A systematic review of randomised trials

Management of Overt Hepatic Encephalopathy

Rifaximina nel trattamento della malattia diverticolare: potenziale terapeutico ed economico

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