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

Authors Kimer N, Krag A, Gluud LL

Received 14 November 2013

Accepted for publication 9 January 2014

Published 18 March 2014 Volume 2014:8 Pages 331—338


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Nina Kimer,1 Aleksander Krag,2 Lise L Gluud1

1Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; 2Department of Gastroenterology, Odense University Hospital, University of Southern Denmark, Odense, Denmark

Abstract: 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.

Keywords: prevention, lactulose, liver cirrhosis

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