Skip to main content
SpringerLink
Log in

Hospitalizations During the Use of Rifaximin Versus Lactulose for the Treatment of Hepatic Encephalopathy

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

We sought to compare frequency and duration of hepatic encephalopathy-related hospitalizations during rifaximin versus lactulose treatment. Hospitalizations, clinical efficacy data, and adverse events obtained from charts of 145 patients with hepatic encephalopathy who received lactulose (30 cc twice daily) for ≥6 months and then rifaximin (400 mg 3 times a day) for ≥6 months compared last 6 months on lactulose (lactulose period) to first 6 months on rifaximin (rifaximin period). Fewer hospitalizations (0.5 versus 1.6; P < .001), fewer days hospitalized (2.5 versus 7.3; P < .001), fewer total weeks hospitalized (0.4 versus 1.8; P < .001), and lower hospitalization charges per patient ($14,222 versus $56,635) were reported during the rifaximin period. More patients had asterixis, diarrhea, flatulence, and abdominal pain during the lactulose period (P < .001). Treatment of hepatic encephalopathy with rifaximin was associated with lower hospitalization frequency and duration, lower hospital charges, better clinical status, and fewer adverse events.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. American Gastroenterology Association (2001) The burden of gastrointestinal diseases. Available at: www.gastro.org/clinicalRes/ burdenReport.html. Accessed 11 April 2005.

  2. Amodio P, Del Piccolo F, Petten E, Mapellli D, Angeli P, Iemmolo R, Muraca M, Musto C, Gerunda G, Rizzo C, Merkel C (2001) Prevalence and prognostic value of quantified electroencephalogram (EEG) alterations in cirrhotic patients. J Hepatol 35:37–45

    Article  PubMed  CAS  Google Scholar 

  3. Nolte W, Wiltfang J, Schindler C, Munke H, Unterberg K, Zumhasch U, Figulla HR, Werner G, Hartmann H, Ramadori G (1998) Portosystemic hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with cirrhosis: clinical, laboratory, psychometric, and electroencephalographic investigations. Hepatology 28:1215–1225

    Article  PubMed  CAS  Google Scholar 

  4. Boyer TD, Haskal ZJ, American Association for the Study of Liver Diseases (2005) The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension. Hepatology 41:1–15

    Article  Google Scholar 

  5. Das A, Dhiman RK, Saraswat VA, Verma M, Naik SR (2001) Prevalence and natural history of subclinical hepatic encephalopathy in cirrhosis. J Gastroenterol Hepatol 16:531–535

    Article  PubMed  CAS  Google Scholar 

  6. Hartmann IJ, Groeneweg M, Quero JC, Beijeman SJ, de Man RA, Hop WC, Schalm SW (2000) The prognostic significance of subclinical hepatic encephalopathy. Am J Gastroenterol 95:2029–2034

    Article  PubMed  CAS  Google Scholar 

  7. Abou-Assi S, Vlahcevic ZR (2001) Hepatic encephalopathy: metabolic consequence of cirrhosis often is reversible. Postgrad Med 109:52–70

    Article  PubMed  CAS  Google Scholar 

  8. Blei AT (2000) Diagnosis and treatment of hepatic encephalopathy. Ballière Clin Gastroenterol 14:959–974

    CAS  Google Scholar 

  9. Agency for Healthcare Research and Quality (2005) HCUPnet, Healthcare Cost and Utilization Project. Agency for Healthcare Research and Quality, Rockville, MD. Available at: http://www. ahrq.gov/data/hcup/. Accessed 24 October 2005.

  10. Riordan SM, Williams R (1997) Treatment of hepatic encephalopathy. N Engl J Med 337:473–479

    Article  PubMed  CAS  Google Scholar 

  11. Maddrey WC (2005) The role of antibiotics in the management of hepatic encephalopathy. Rev Gastroenterol Disord 5(suppl 1):S3–S9

    PubMed  Google Scholar 

  12. Williams R, Bass N (2005) Rifaximin, a nonabsorbed oral antibiotic, in the treatment of hepatic encephalopathy: antimicrobial activity, efficacy, and safety. Rev Gastroenterol Disord 5(suppl 1):S10–S8

    PubMed  Google Scholar 

  13. Pakyz AL (2005) Rifaximin: a new treatment for travelers’ diarrhea. Ann Pharmacother 39:284–289

    Article  PubMed  CAS  Google Scholar 

  14. Huang DB, DuPont HL (2005) Rifaximin – a novel antimicrobial for enteric infections. J Infect 50:97–106

    Article  PubMed  Google Scholar 

  15. Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT, the Members of the Working Party (2002) Hepatic encephalopathy – definition, nomenclature, diagnosis, and quantification: final report of the Working Party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology 35:716–721

    Article  PubMed  Google Scholar 

  16. Miura M, Nomoto Y, Sakai H (1989) Short term effect of lactulose therapy in patients with chronic renal failure. Tokai J Exp Clin Med 14:29–34

    PubMed  CAS  Google Scholar 

  17. Morgan MY (1991) The treatment of chronic hepatic encephalopathy. Hepatogastroenterology 38:377–387

    PubMed  CAS  Google Scholar 

  18. Conn HO (1988) Adverse reactions and side effects of lactulose and related agents. In: Conn HO, Bircher J, eds. Hepatic encephalopathy: management with lactulose and related carbohydrates. Medi-Ed Press, East Lansing, MI, pp 199–206

  19. Bass NM, Gardner JD, Kamm AR (2004, October 29–November 2) Rifaximin is beneficial for the treatment of hepatic encephalopathy. Presented at the 53rd Annual Meeting of the American Association for the Study of Liver Diseases; Boston, MA.

  20. Steffen R, Sack DA, Riopel L, Jiang ZD, Sturchler M, Ericsson CD, Lowe B, Waiyaki P, White M, DuPont HL (2003) Therapy of travelers’ diarrhea with rifaximin on various continents. Am J Gastroenterol 98:1073–1078

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The New Jersey Medical Liver Center, 90 Bergen Street, Suite 2100, Newark, NJ, 07103, USA

    Carroll B. Leevy

  2. Sage Statistical Solutions, Inc, Efland, North Carolina, USA

    James A. Phillips

Authors
  1. Carroll B. Leevy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James A. Phillips
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carroll B. Leevy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leevy, C.B., Phillips, J.A. Hospitalizations During the Use of Rifaximin Versus Lactulose for the Treatment of Hepatic Encephalopathy. Dig Dis Sci 52, 737–741 (2007). https://doi.org/10.1007/s10620-006-9442-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-006-9442-4

Keywords

Search

Navigation