Rifaximin in the treatment of hepatic encephalopathy

Abstract

Forty patients (29 males and 11 females) with a mean age of 59 years (range 45-72 years) affected by mild hepatic portal systemic encephalopathy (PSE) were monitored in a double blind, double dummy trial for 90 days in the course of treatment with rifaximin (20 patients, 1200 mg/day) or lactulose (control group, 20 patients, 120 ml/day), with administration of the drugs in the first two weeks of each month. Both treatments were shown to be effective in controlling the neurological signs and symptoms of hepatic encephalopathy: the excessive levels of serum ammonia present at the start of the treatment decreased, generally returning to normal after the tenth day of therapy. At the end of the treatment period with rifaximin, the severity of PSE had clearly regressed in all cases; a good improvement was also noted in the control group, with mild PSE in four cases and no PSE in the remaining 16 cases. The therapeutic efficacy of rifaximin appeared to be greater both in terms of its speed of onset of action and its appropriateness of use. From the results of this study, rifaximin appears to be extremely promising for the treatment of PSE; additional benefits are the absence of gastrointestinal absorption and its broad spectrum of action inhibiting ammonia-producing bacteria. Tolerability was also high, with no undesired systemic effects reported.