Add-on Therapeutic Effects of Rifaximin on Treatment-resistant Hepatic Encephalopathy

Objective Rifaximin is used to treat hepatic encephalopathy. However, whether or not rifaximin and lactu-lose combination therapy can enhance the treatment outcomes and reduce the hospitalization rate of patients with hepatic encephalopathy that are resistant to lactulose has yet to be determined. The present study inves-tigated the hospitalization rate before and after rifaximin add-on therapy in patients resistant to lactulose. Methods A total of 36 patients who were resistant to lactulose with add-on rifaximin therapy were en-rolled. Patients who were hospitalized and/or did not achieve normalization of ammonia levels under lactu-lose administration were defined as treatment-resistant. The primary outcome was the change in hospitaliza-tion rate due to hepatic encephalopathy at 24 weeks before and after rifaximin administration. Results Before rifaximin administration, 15 (41.6%) patients were hospitalized due to hepatic encephalopa-thy. After rifaximin administration, 8 (22.2%) patients were hospitalized due to hepatic encephalopathy. The hospitalization rates were significantly reduced after rifaximin administration (p=0.02). The median (inter -quartile range) ammonia levels upon rifaximin administration (baseline) and 8, 12, and 24 weeks after rifaxi-min administration were 124 (24-310) mu g/dL, 78 (15-192) mu g/dL, 67 (21-233) mu g/dL, and 77 (28-200) mu g/dL, respectively. Furthermore, the ammonia levels were significantly reduced by rifaximin add-on therapy (p= 0.005, p=0.01, and p=0.01). Conclusion The addition of rifaximin to lactulose treatment in treatment-resistant patients decreases the hospitalization rate among patients with hepatic encephalopathy and may be used as an add-on treatment.

Automated summary

This study investigated the change in hospitalization rate before and after rifaximin add-on therapy in lactulose resistant patients with hepatic encephalopathy. The findings showed that rifaximin administration significantly reduced the hospitalization rate and ammonia levels among treatment-resistant patients, suggesting that rifaximin can be used as an add-on treatment for hepatic encephalopathy.