College of Pharmacy & Health Sciences, Texas Southern University, Houston, TX 77004, USA.
Ann Pharmacother. 2009 Jan;43(1):77-84. doi: 10.1345/aph.1K436. Epub 2008 Dec 17.
To review the effectiveness and safety of rifaximin in the treatment of hepatic encephalopathy (HE).
MEDLINE (1990-October 2008) was searched using the terms rifaximin, rifamycins, hepatic encephalopathy, liver cirrhosis, and acute liver failure. Other sources included the bibliographies of pertinent articles as well as programs and abstracts from infectious diseases and gastrointestinal diseases meetings.
All English-language articles identified from the search were evaluated. All primary literature that addressed the efficacy and safety of rifaximin in the treatment of HE was included in this review.
HE is a complex neuropsychiatric syndrome seen in patients with liver failure. It is characterized by disturbances in consciousness and behavior, personality changes, fluctuating neurologic signs, asterixis, and electroencephalographic changes. Although the etiology of HE is unknown, the accumulation of several gut-derived toxins such as mercaptans, ammonia, and benzodiazepine has been implicated. Current treatment options for HE include agents that reduce the concentration of these toxins, such as nonabsorbable disaccharides and antibiotics. Several studies have evaluated the use of rifaximin in the treatment of HE. They include a dose-finding study, 9 open-label studies, and 4 double-blind studies comparing rifaximin with either nonabsorbable disaccharides or antibiotics. Commonly used outcomes in most of these studies were changes in portal systemic encephalopathy index and the improvement in HE grade. Despite various limitations of the studies, rifaximin showed superior efficacy compared with lactulose for the treatment of HE, similar efficacy to paromomycin, and similar or greater efficacy than neomycin. Rifaximin was found to be associated with fewer hospitalizations, fewer days of hospitalization, and lower hospitalization charges than were seen with lactulose. Rifaximin also had a better tolerance profile than the comparative agents.
Rifaximin appears to be an effective and safe treatment option for HE. Better-designed studies are needed to characterize its efficacy in the treatment of HE.
综述利福昔明治疗肝性脑病（HE）的有效性和安全性。
使用利福昔明、利福霉素、肝性脑病、肝硬化和急性肝衰竭等术语检索 MEDLINE（1990 年 10 月至 2008 年）。其他来源包括相关文章的参考文献以及传染病和胃肠病会议的方案和摘要。
评估了从检索中获得的所有英文文章。本综述纳入了所有探讨利福昔明治疗 HE 疗效和安全性的原始文献。
HE 是一种见于肝衰竭患者的复杂神经精神综合征。其特征为意识和行为紊乱、人格改变、波动性神经体征、扑翼样震颤和脑电图改变。虽然 HE 的病因尚不清楚，但推测与几种肠道来源的毒素（如硫醇、氨和苯二氮䓬）的积聚有关。HE 的当前治疗方法包括降低这些毒素浓度的药物，如不可吸收的双糖和抗生素。有几项研究评估了利福昔明治疗 HE 的作用。这些研究包括剂量确定研究、9 项开放性研究和 4 项双盲研究，将利福昔明与不可吸收的双糖或抗生素进行了比较。这些研究中的大多数常用结局为门体脑病指数的变化和 HE 严重程度的改善。尽管这些研究存在各种局限性，但利福昔明在治疗 HE 方面优于乳果糖、与巴龙霉素疗效相似、且与新霉素相比疗效相似或更优。与乳果糖相比，利福昔明导致住院次数减少、住院天数减少和住院费用降低。利福昔明的耐受情况也优于对照药物。
利福昔明似乎是治疗 HE 的一种有效且安全的治疗选择。需要更好设计的研究来确定其在治疗 HE 中的疗效。
