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Rifaximin Plus Lactulose Reduces Severity of Hepatic Encephalopathy
by mikesimon, Nov 05, 2008 02:28PM
Rifaximin Plus Lactulose Reduces Severity of Hepatic Encephalopathy
By Martha Kerr
SAN FRANCISCO (Reuters Health) Nov 04 - The non-absorbed antibiotic rifaximin (Xifaxan, Salix Pharmaceuticals) added to standard treatment of hepatic encephalopathy with lactulose significantly reduces the number of hospitalizations for hepatic encephalopathy and shortens the length of hospital stay.
Those findings were presented here at The Liver Meeting 2008, the annual meeting of the American Association for the Study of Liver Diseases (AASLD) by Dr. Parvez S. Mantry of The Liver Institute at Methodist Dallas Medical Center, Texas.
Dr. Mantry described a retrospective review of medical records of 123 patients with end-stage liver disease seen on the liver transplantation unit at his institution. Fifty-eight of the patients received lactulose monotherapy for a mean duration of 24 months, while 65 patients received adjunctive rifaximin, 400-1200 mg/day, for a mean duration of 14 months after lactulose monotherapy.
"The risk of hospitalization for hepatic encephalopathy during adjunctive rifaximin treatment was 87% lower than during the preceding period with lactulose monotherapy," Dr. Mantry told meeting attendees.
Mean hospitalizations per patient were 0.26 with rifaximin plus lactulose and 0.95 with lactulose alone, for an odds ratio (OR) of 0.13.
The mean duration of hospitalizations for hepatic encephalopathy was shorter during adjunctive rifaximin (1.1 days) compared with lactulose monotherapy (2.4 days).
Treatment, age, and MELD score were independent predictors of hospitalization for hepatic encephalopathy.
"By reducing hospitalizations, rifaximin may reduce morbidity associated with hospitalization and overall costs associated with hepatic encephalopathy," Dr. Mantry concluded, adding, "Prospective studies to further investigate the potential therapeutic and pharmaco-economic benefits of rifaximin for hepatic encephalopathy are ongoing."
http://www.medscape.com/viewarticle/583017?sssdmh=dm1.401126&src=nldne
Mike
By Martha Kerr
SAN FRANCISCO (Reuters Health) Nov 04 - The non-absorbed antibiotic rifaximin (Xifaxan, Salix Pharmaceuticals) added to standard treatment of hepatic encephalopathy with lactulose significantly reduces the number of hospitalizations for hepatic encephalopathy and shortens the length of hospital stay.
Those findings were presented here at The Liver Meeting 2008, the annual meeting of the American Association for the Study of Liver Diseases (AASLD) by Dr. Parvez S. Mantry of The Liver Institute at Methodist Dallas Medical Center, Texas.
Dr. Mantry described a retrospective review of medical records of 123 patients with end-stage liver disease seen on the liver transplantation unit at his institution. Fifty-eight of the patients received lactulose monotherapy for a mean duration of 24 months, while 65 patients received adjunctive rifaximin, 400-1200 mg/day, for a mean duration of 14 months after lactulose monotherapy.
"The risk of hospitalization for hepatic encephalopathy during adjunctive rifaximin treatment was 87% lower than during the preceding period with lactulose monotherapy," Dr. Mantry told meeting attendees.
Mean hospitalizations per patient were 0.26 with rifaximin plus lactulose and 0.95 with lactulose alone, for an odds ratio (OR) of 0.13.
The mean duration of hospitalizations for hepatic encephalopathy was shorter during adjunctive rifaximin (1.1 days) compared with lactulose monotherapy (2.4 days).
Treatment, age, and MELD score were independent predictors of hospitalization for hepatic encephalopathy.
"By reducing hospitalizations, rifaximin may reduce morbidity associated with hospitalization and overall costs associated with hepatic encephalopathy," Dr. Mantry concluded, adding, "Prospective studies to further investigate the potential therapeutic and pharmaco-economic benefits of rifaximin for hepatic encephalopathy are ongoing."
http://www.medscape.com/viewarticle/583017?sssdmh=dm1.401126&src=nldne
Mike
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"reduce morbidity " - I've never thought of brain fog as being lethal!???
In answer to your question, my understanding of the article suggests that the Rifaximin would be added to the lactulose as a preventative measure and not as a curative one so it probably should be taken daily - according to this article, that is.
"Morbidity" was used in the context of hospitalizations:
"By reducing hospitalizations, rifaximin may reduce morbidity associated with hospitalization and overall costs associated with hepatic encephalopathy,"
It appears that the increased morbidity is associated with hospital stays which is a little unsettling. After my liver transplant my surgeon asked me if I wanted to go home the next day - leave on day 5. I said I would do what he thought was best and he said that my biggest risk was infection and the hospital was a dangerous place to be when the risk in infection.
I think the bottom line is that you should discuss with your doctor your episodes, their cause and how best to control them.
Good luck,
Mike