Can rifaximin for hepatic encephalopathy be discontinued during broad-spectrum antibiotic treatment?  

作　　者：Chien-Hao Huang Piero Amodio 

机构地区：[1]Division of Hepatology,Department of Gastroenterology and Hepatology,Chang-Gung Memorial Hospital,Linkou Medical Center,Taoyuan 333,Taiwan [2]Department of Clinical and Experimental Medicine,University of Padua,Padova 35122,Italy

出　　处：《World Journal of Hepatology》2024年第2期115-119,共5页世界肝病学杂志（英文版）（电子版）

基　　金：Supported by the Chang Gung Medical Research Project,No.CMRPG3M1931-1932;the National Science and Technology Council,No.MOST 110-2314-B-182A-093-and No.NMRPG3L0331.

摘　　要：Hepatic encephalopathy(HE)is a formidable complication in patients with decompensated cirrhosis,often necessitating the administration of rifaximin(RFX)for effective management.RFX,is a gut-restricted,poorly-absorbable oral rifamycin derived antibiotic that can be used in addition to lactulose for the secondary prophylaxis of HE.It has shown notable reductions in infection,hospital readmission,duration of hospital stay,and mortality.However,limited data exist about the concurrent use of RFX with broad-spectrum antibiotics,because the patients are typically excluded from studies assessing RFX efficacy in HE.A pharmacist-driven quasi-experimental pilot study was done to address this gap.They argue against the necessity of RFX in HE during broad-spectrum antibiotic treatment,particularly in critically ill patients in intensive care unit(ICU).The potential for safe RFX discontinuation without adverse effects is clearly illuminated and valuable insight into the optimization of therapeutic strategies is offered.The findings also indicate that RFX discontinuation during broadspectrum antibiotic therapy was not associated with higher rates of delirium or coma,and this result remained robust after adjustment in multivariate analysis.Furthermore,rates of other secondary clinical and safety outcomes,including ICU mortality and 48-hour changes in vasopressor requirements,were comparable.However,since the activity of RFX is mainly confined to the modulation of gut microbiota,its potential utility in patients undergoing extensive systemic antibiotic therapy is debatable,given the overlapping antibiotic activity.Further,this suggests that the action of RFX on HE is class-specific(related to its activity on gut microbiota),rather than drug-specific.A recent double-blind randomized controlled(ARiE)trial provided further evidence-based support for RFX withdrawal in critically ill cirrhotic ICU patients receiving broad-spectrum antibiotics.Both studies prompt further discussion about optimal therapeutic strategy for patients facing

关 键 词：Rifaximin discontinuation Hepatic encephalopathy Broad-spectrum antibiotics Crit-ically ill Medical intensive care unit Pharmacist-driven protocol 

分 类 号：R97[医药卫生—药品] R743[医药卫生—药学]