Primary prophylaxis of hepatic encephalopathy in decompensated cirrhosis: Low dose vs. full dose rifaximin

Rifaximin for Primary Prophylaxis of PSE

  • Shahid Sarwar Services Institute of Medical Sciences
  • Bushra Muhyuddin Services Institute of Medical Sciences
  • Abdul Aleem Services Institute of Medical Sciences
  • Muhammad Arif Nadeem Services Institute of Medical Sciences
Keywords: Decompensated cirrhosis, Portosystemic encephalopathy, Primary prophylaxis, Rifaximin

Abstract

Objective: To compare efficacy of high vs low dose rifaximin for primary prophylaxis of portosystemic encephalopathy (PSE) in decompensated liver cirrhosis.

Methods: In a quasi-experimental double blind randomized study at Services Institute of Medical Sciences (SIMS), Lahore from August 2017 to August 2018, patients of decompensated cirrhosis with no previous PSE were randomized to receive twice daily rifaximin 200mg in Group-A and 550mg in Group-B. Patients were followed for 6 months for development of PSE.

Results: In 75 included patients, mean age was 53.8(±10.7) years and male/female ratio was 0.97/1(37/38). After randomization, 34 (45.3%) patients were included in Group-A and 41 (54.7%) patients in Group-B. During 6 month follow up 24 (32%) patients developed PSE, 12 (35.2%) in Group-A and 12 (29.2%) in Group-B, difference was not significant (p value 0.57). In 6 months, 13 (17.3%) patient died, 6 (17.6%) in Group-A and 7 (17.07%) patients in Group-B, difference not significant (p value 0.94). Patients who died had higher bilirubin (p < 0.00), higher serum creatinine (p 0.05), high CTP score (p 0.04) and worse MELD score (p 0.004).

Conclusion: Rifaximin is not effective for primary prophylaxis of overt hepatic encephalopathy in decompensated cirrhosis patients.

doi: https://doi.org/10.12669/pjms.35.5.549

How to cite this:
Sarwar S, Muhyuddin B, Aleem A, Nadeem MA. Primary prophylaxis of hepatic encephalopathy in decompensated cirrhosis: Low dose vs. full dose rifaximin. Pak J Med Sci. 2019;35(5):1446-1450. doi: https://doi.org/10.12669/pjms.35.5.549

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Author Biography

Shahid Sarwar, Services Institute of Medical Sciences

Associate Professor of Medicine

Department of Medicine, Services Institute of Medical Sciences Lahore

Consultant Gastroenterologist

Doctors Hospital and Medical Center Lahore

Published
2019-08-22
Section
Original Articles