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Metabolic Brain Disease

Erschienen in:

01.06.2013 | Original Paper

Antibiotics for the treatment of hepatic encephalopathy

verfasst von: Kavish R. Patidar, Jasmohan S. Bajaj

Erschienen in: Metabolic Brain Disease | Ausgabe 2/2013

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Abstract

The treatment of hepatic encephalopathy (HE) is complex and therapeutic regimens vary according to the acuity of presentation and the goals of therapy. Most treatments for HE rely on manipulating the intestinal milieu and therefore antibiotics that act on the gut form a key treatment strategy. Prominent antibiotics studied in HE are neomycin, metronidazole, vancomycin and rifaximin. For the management of the acute episode, all antibiotics have been tested. However the limited numbers studied, adverse effects (neomycin oto- and nephrotoxicity, metronidazole neurotoxicity) and potential for resistance emergence (vancomycin-resistant enterococcus) has limited the use of most antibiotics, apart from rifaximin which has the greatest evidence base. Rifaximin has also demonstrated, in conjunction with lactulose, to prevent overt HE recurrence in a multi-center, randomized trial. Despite its cost in the US, rifaximin may prove cost-saving by preventing hospitalizations for overt HE. In minimal/covert HE, rifaximin is the only systematically studied antibiotic. Rifaximin showed improvement in cognition, inflammation, quality-of-life and driving simulator performance but cost-analysis does not favor its use at the current time. Antibiotics, especially rifaximin, have a definite role in the management across the spectrum of HE.

Alcorn J (2008) Review: rifaximin is equally or more effective than other antibiotics and lactulose for hepatic encephalopathy. ACP J Club 149(5):11PubMed

Atterbury CE, Maddrey WC, Conn HO (1978) Neomycin-sorbitol and lactulose in the treatment of acute portal-systemic encephalopathy: a controlled, double-blind clinical trial. Am J Dig Dis 23:398–406PubMedCrossRef

Bajaj JS (2010) Review article: the modern management of hepatic encephalopathy. Aliment Pharmacol Ther 31(5):537–547PubMedCrossRef

Bajaj JS, Riggio O (2010) Drug therapy: rifaximin. Hepatology 52(4):1484–1488PubMedCrossRef

Bajaj JS, Heuman DM, Wade JB, Gibson DP, Saeian K, Wegelin JA, Hafeezullah M, Bell DE, Sterling RK, Stravitz RT, Fuchs M, Luketic V, Sanyal AJ (2011) Rifaximin improves driving simulator performance in a randomized trial of patients with minimal hepatic encephalopathy. Gastroenterology 140(2):478–487PubMedCrossRef

Bajaj JS, Hylemon PB, Ridlon JM, Heuman DM, Daita K, White MB, Monteith P, Noble NA, Sikaroodi M, Gillevet PM (2012a) Colonic mucosal microbiome differs from stool microbiome in cirrhosis and hepatic encephalopathy and is linked to cognition and inflammation. Am J Physiol Gastrointest Liver Physiol 303(6):G675–G685PubMedCrossRef

Bajaj JS, O’Leary JG, Reddy KR, Wong F, Olson JC, Subramanian RM, Brown G, Noble NA, Thacker LR, Kamath PS (2012b) Second infections independently increase mortality in hospitalized patients with cirrhosis: the north american consortium for the study of end-stage liver disease (NACSELD) experience. Hepatology 56(6):2328–2335PubMedCrossRef

Bajaj JS, Pinkerton SD, Sanyal AJ, Heuman DM (2012c) Diagnosis and treatment of minimal hepatic encephalopathy to prevent motor vehicle accidents: a cost-effectiveness analysis. Hepatology 55(4):1164–1171PubMedCrossRef

Bass NM, Mullen KD, Sanyal A, Poordad F, Neff G, Leevy CB, Sigal S, Sheikh MY, Beavers K, Frederick T, Teperman L, Hillebrand D, Huang S, Merchant K, Shaw A, Bortey E, Forbes WP (2010) Rifaximin treatment in hepatic encephalopathy. N Engl J Med 362(12):1071–1081PubMedCrossRef

Blei AT, Cordoba J (2001) Hepatic encephalopathy. Am J Gastroenterol 96:1968–1976PubMedCrossRef

Brigidi P, Swennen E, Rizzello F, Bozzolasco M, Matteuzzi D (2012) Effects of rifaximin administration on the intestinal microbiota in patients with ulcerative colitis. J Chemother 14(3):290–295

Bucci L, Palmieri GC (1993) Double-blind, double-dummy comparison between treatment with rifaximin and lactulose in patients with medium to severe degree hepatic encephalopathy. Curr Med Res Opin 13:109–118PubMedCrossRef

Conn HO, Leevy CM, Vlahcevic ZR, Rodgers JB, Maddrey WC, Seeff L, Levy LL (1977) Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy. A double blind controlled trial. Gastroenterology 72(4 Pt 1):573–583PubMed

Fera G, Agostinacchio F, Nigro M, Schiraldi O, Ferrieri A (1993) Rifaximin in the treatment of hepatic encephalopathy. Eur J Clin Res 4(1):57–66

Fernández J, Acevedo J, Castro M, Garcia O, de Lope CR, Roca D, Pavesi M, Sola E, Moreira L, Silva A, Seva-Pereira T, Corradi F, Mensa J, Ginès P, Arroyo V (2012) Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: a prospective study. Hepatology 55(5):1551–1561PubMedCrossRef

Festi D, Mazzella G, Orsini M, Scottili S, Sangermano A, Li Bassi S, Ferrieri A, Falcucci M, Grossi L, Marzio L, Roda E (1993) Rifaximin in the treatment of chronic hepatic encephalopathy: results of a multicenter study of efficacy and safety. Curr Ther Res 54(5):598–609CrossRef

Gustot T, Durand F, Lebrec D, Vincent JL, Moreau R (2009) Severe Sepsis in cirrhosis. Hepatology 50(6):2022–2033PubMedCrossRef

Huang E, Esrailian E, Spiegel BMR (2007) The cost-effectiveness and budget impact of competing therapies in hepatic encephalopathy: a decision analysis. Aliment Pharmacol Ther 26:1147–1161PubMedCrossRef

Jalan R (2010) Rifaximin in hepatic encephalopathy: more than just a non-absorable antibiotic? J Hepatol 53(3):580–582PubMedCrossRef

Jiang ZD, DuPont HL (2005) Rifaximin: in vitro and in vivo antibacterial activity–a review. Chemotherapy 51(Suppl 1):67–72PubMedCrossRef

Kalambokis GN, Mouzaki A, Rodi M, Pappas K, Fotopoulos A, Xourgia X, Tsiansos EV (2012) Rifaximin improves systemic hemodynamics and renal function in patients with alchol-related cirrhosis and ascites. Clin Gastroenterol Hepatol 10(7):815–818PubMedCrossRef

Leevy CB, Phillips JA (2007) Hospitalizations during the use of rifaximin versus lactulose for the treatment of hepatic encephalopathy. Dig Dis Sci 52:737–741PubMedCrossRef

Loft S, Sonne J, Dossing M, Andreasen PB (1987) Metronidazole pharmacokinetics in patients with hepatic encephalopathy. Scand J Gastroenterol 22(1):117–123PubMedCrossRef

Mantry PS, Munsaf S (2010) Rifaximin for the treatment of hepatic encephalopathy. Transplant Proc 42(10):4543–4547PubMedCrossRef

Marco F, Amato PS, D’Arienzo A (1984) Rifaximin in collateral treatment of portal-systemic encephalopathy: a preliminary report. Curr Ther Res 36:668–674

Mas A, Rodés J, Sunyer L, Rodrigo L, Planas R, Vargas V, Castells L, Rodríguez-Martínez D, Fernández-Rodríguez C, Coll I, Pardo A (2003) Spanish Association for the Study of the Liver Hepatic Encephalopathy Cooperative Group. Comparison of rifaximin and lactitol in the treatment of acute hepatic encephalopathy: results of a randomized, double-blind, double-dummy, controlled clinical trial. J Hepatol 38(1):51–58PubMedCrossRef

Massa P, Vallerino E, Dodero M (1993) Treatment of hepatic encephalopathy with rifaximin: double-blind, double-dummy study versus lactulose. Eur J Clin Res 4:7–18

Morgan MH, Read AE, Speller DC (1982) Treatment of hepatic encephalopathy with metronidazole. Gut 23(1):1–7PubMedCrossRef

Neff GW, Kemmer N, Kaiser T, Zacharias V, Majoras N, Safdar K (2007) Outcomes in adult and pediatric liver transplantation among various ethnic groups. Transplant Proc 39(10):3204–3206PubMedCrossRef

Neff GW, Jones M, Broda T, Jonas M, Ravi R, Novick D, Kaiser TE, Kemmer N (2012) Durability of rifaximin response in hepatic encephalopathy. J Clin Gastroenterol 46(2):168–171PubMedCrossRef

Orlandi F, Freddara U, Candelaresi MT, Morettini A, Corazza GR, Di Simone A, Dobrilla G, Cavallini G (1981) Comparison between neomycin and lactulose in 173 patients with hepatic encephalopathy: a randomized clinical study. Dig Dis Sci 26(6):498–506PubMedCrossRef

Paik YH, Lee KS, Han KH, Song KH, Kim MH, Moon BS, Ahn SH, Lee SJ, Park HJ, Lee DK, Chon CY, Lee SI, Moon YM (2005) Comparison of rifaximin and lactulose for the treatment of hepatic encephalopathy: a prospective randomized study. Yonsei Med J 46(3):399–407PubMedCrossRef

Parini P, Cipolla A, Ronci M, Antionio M, Salzetta A, Mazzella G, Roda E (1992) Effect of paromomycin in the treatment of portal-systemic encephalopathy. Curr Ther Res 52:34CrossRef

Poh Z, Chang PE (2012) A current review of the diagnostic and treatment strategies of hepatic encephalopathy. Int J Hepatol 2012:480309PubMed

Poordad FF (2007) Review article: the burden of hepatic encephalopathy. Aliment Pharmacol Ther 1:3–9CrossRef

Prakash R, Mullen KD (2010) Mechanisms, diagnosis and management of hepatic encephalopathy. Nat Rev Gastroenterol Hepatol 7:515–525PubMedCrossRef

Riggio O, Mannaioni G, Ridola L, Angeloni S, Merli M, Carlà V, Salvatori FM, Moroni F (2010) Peripheral and splanchnic indole and oxindole levels in cirrhotic patients: a study on the pathophysiology of hepatic encephalopathy. Am J Gastroenterol 105(6):1374–1381PubMedCrossRef

Sanyal A, Bass N, Poorad F, Sheikh MY, Mullen K, Sigal S, Frederick T, Brown, Jr R, Bhandari B, Sedghi S, Merchant K, Huang S, Shaw A, Bortey E, Forbes W (2010) Rifaximin decreases venous ammonia concentrations and time-weighted average ammonia concentrations correlate with overt hepatic encephalopathy (HE) as assessed by Conn Score in a 6-months study. Program and abstracts of the 45th Annual Meeting of the European Association for the Study of the Liver Abstract 195

Sanyal A, Younossi ZM, Bass NM, Mullen KD, Poordad F, Brown RS, Vemuru RP, Mazen Jamal M, Huang S, Merchant K, Bortey E, Forbes WP (2011) Randomised clinical trial: rifaximin improves health-related quality of life in cirrhotic patients with hepatic encephalopathy – a double-blind placebo-controlled study. Aliment Pharmacol Ther 34(8):853–861PubMedCrossRef

Shawcross DL, Sharifi Y, Canavan JB, Yeoman AD, Abeles RD, Taylor NJ, Auzinger G, Bernal W, Wendon JA (2011) Infection and systemic inflammation, not ammonia, are associated with Grade 3/4 hepatic encephalopathy, but not mortality in cirrhosis. J Hepatol 54:640–649PubMedCrossRef

Sidhu SS, Goyal O, Mishra BP, Sood A, Chhina RS, Soni RK (2011) Rifaximin improves psychometric performance and health-related quality of life in patients with minimal hepatic encephalopathy (the RIME Trial). Am J Gastroenterol 106(2):307–316PubMedCrossRef

Stepanova M, Mishra A, Venkatesan C, Younossi ZM (2012) In-hospital mortality and economic burden associated with hepatic encephalopathy in the United States from 2005 to 2009. Clin Gastroenterol Hepatol 10(9):1034–1041PubMedCrossRef

Strauss E, Tramote R, Silva EP, Caly WR, Honain NZ, Maffei RA, de Sá MF (1992) Double-blind randomized clinical trial comparing neomycin and placebo in the treatment of exogenous hepatic encephalopathy. Hepatogastroenterology 39(6):542–545PubMed

Tarao K, Ikeda T, Hayashi K, Sakurai A, Okada T, Ito T, Karube H, Nomoto T, Mizuno T, Shindo K (1990) Successful use of vancomycin hydrochloride in the treatment of lactulose resistant chronic hepatic encephalopathy. Gut 31(6):702–706PubMedCrossRef

Testa R, Eftimiadi C, Sukkar GS, De Leo C, Rovida S, Schito GC, Celle G (1985) Drugs Exp Clin Res 11(6):387–392PubMed

U.S. Food and Drug Administration (2010) Briefing Document for Gastrointestinal Drugs Advisory Committee Meeting 23 February 2010. http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/GastrointestinalDrugsAdvisoryCommittee/UCM201081.pdf. Accessed 3 December 2012

Titel: Antibiotics for the treatment of hepatic encephalopathy
verfasst von: Kavish R. Patidar
Jasmohan S. Bajaj
Publikationsdatum: 01.06.2013
Verlag: Springer US
Erschienen in: Metabolic Brain Disease / Ausgabe 2/2013
Print ISSN: 0885-7490
Elektronische ISSN: 1573-7365
DOI: https://doi.org/10.1007/s11011-013-9383-5

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