Lawrence Kenneth R, Klee Jacqueline A
Department of Pharmacy, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA.
Pharmacotherapy. 2008 Aug;28(8):1019-32. doi: 10.1592/phco.28.8.1019.
To review the effectiveness and safety of rifaximin for the treatment of hepatic encephalopathy.
A literature search was conducted of MEDLINE (1966-September 2007), the Cochrane Database of Systematic Reviews (1995-2007), and the Cochrane Hepato-Biliary Group Reviews (2003-2007). English-language articles identified from the data sources were evaluated. All available studies were reviewed, including placebo-controlled, treatment comparison, and open label.
Rifaximin was effective in improving behavioral, laboratory, mental status, and intellectual abnormalities associated with hepatic encephalopathy. Some studies demonstrated superior and more rapid improvement in signs or symptoms of encephalopathy during treatment with rifaximin compared with nonabsorbable disaccharides (lactulose, lactitol). Patients treated with rifaximin also required less hospitalization, had shorter duration of hospitalization, and lower hospital charges compared with lactulose-treated patients. Adverse effects of rifaximin were mostly minor gastrointestinal complaints; however, rifaximin was better tolerated than other pharmacologic treatments.
Rifaximin was at least equally effective as and in some studies superior to nonabsorbable disaccharides and antimicrobials in relieving signs or symptoms observed in patients with mild-to-moderately severe hepatic encephalopathy. Future clinical trials should focus on using standardized methods of evaluating mental status and limiting enrollment to patients with mild-to-moderate, episodic, persistent, or minimal hepatic encephalopathy. Well-designed studies are needed to fully delineate the efficacy of rifaximin and other pharmacologic treatments for patients with hepatic encephalopathy.
回顾利福昔明治疗肝性脑病的有效性和安全性。
对MEDLINE（1966年至2007年9月）、Cochrane系统评价数据库（1995年至2007年）以及Cochrane肝胆组评价（2003年至2007年）进行文献检索。对从数据源中识别出的英文文章进行评估。回顾了所有可用的研究，包括安慰剂对照、治疗比较和开放标签研究。
利福昔明在改善与肝性脑病相关的行为、实验室检查、精神状态和智力异常方面有效。一些研究表明，与非吸收性双糖（乳果糖、乳糖醇）相比，利福昔明治疗期间肝性脑病的体征或症状改善更显著、更迅速。与接受乳果糖治疗的患者相比，接受利福昔明治疗的患者住院需求更少，住院时间更短，住院费用更低。利福昔明的不良反应大多为轻微的胃肠道不适；然而，与其他药物治疗相比，利福昔明的耐受性更好。
在缓解轻至中度严重肝性脑病患者的体征或症状方面，利福昔明至少与非吸收性双糖和抗菌药物同样有效，在某些研究中优于它们。未来的临床试验应侧重于使用标准化的精神状态评估方法，并将入组限制在轻度至中度、发作性、持续性或轻微肝性脑病患者。需要设计良好的研究来全面描述利福昔明和其他药物治疗对肝性脑病患者的疗效。
