Digestive Diseases and Sciences

, Volume 52, Issue 3, pp 737–741 | Cite as

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

Original Article

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.

Keywords

Hepatic encephalopathy Rifaximin Lactulose Hospitalization 

References

  1. 1.
    American Gastroenterology Association (2001) The burden of gastrointestinal diseases. Available at: www.gastro.org/clinicalRes/ burdenReport.html. Accessed 11 April 2005.Google Scholar
  2. 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 35:37–45PubMedCrossRefGoogle Scholar
  3. 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 28:1215–1225PubMedCrossRefGoogle Scholar
  4. 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 41:1–15CrossRefGoogle Scholar
  5. 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 16:531–535PubMedCrossRefGoogle Scholar
  6. 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 95:2029–2034PubMedCrossRefGoogle Scholar
  7. 7.
    Abou-Assi S, Vlahcevic ZR (2001) Hepatic encephalopathy: metabolic consequence of cirrhosis often is reversible. Postgrad Med 109:52–70PubMedCrossRefGoogle Scholar
  8. 8.
    Blei AT (2000) Diagnosis and treatment of hepatic encephalopathy. Ballière Clin Gastroenterol 14:959–974Google Scholar
  9. 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.Google Scholar
  10. 10.
    Riordan SM, Williams R (1997) Treatment of hepatic encephalopathy. N Engl J Med 337:473–479PubMedCrossRefGoogle Scholar
  11. 11.
    Maddrey WC (2005) The role of antibiotics in the management of hepatic encephalopathy. Rev Gastroenterol Disord 5(suppl 1):S3–S9PubMedGoogle Scholar
  12. 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–S8PubMedGoogle Scholar
  13. 13.
    Pakyz AL (2005) Rifaximin: a new treatment for travelers’ diarrhea. Ann Pharmacother 39:284–289PubMedCrossRefGoogle Scholar
  14. 14.
    Huang DB, DuPont HL (2005) Rifaximin – a novel antimicrobial for enteric infections. J Infect 50:97–106PubMedCrossRefGoogle Scholar
  15. 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 35:716–721PubMedCrossRefGoogle Scholar
  16. 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 14:29–34PubMedGoogle Scholar
  17. 17.
    Morgan MY (1991) The treatment of chronic hepatic encephalopathy. Hepatogastroenterology 38:377–387PubMedGoogle Scholar
  18. 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 199–206Google Scholar
  19. 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.Google Scholar
  20. 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 98:1073–1078PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science&#x002B;Business Media, Inc. 2006

Authors and Affiliations

  1. 1.The New Jersey Medical Liver Center, 90 Bergen StreetNewarkUSA
  2. 2.Sage Statistical Solutions, IncEflandUSA

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