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

作     者：Chien-Hao Huang Piero Amodio 

作者机构：Division of HepatologyDepartment of Gastroenterology and HepatologyChang-Gung Memorial HospitalLinkou Medical CenterTaoyuan 333Taiwan Department of Clinical and Experimental MedicineUniversity of PaduaPadova 35122Italy 

出 版 物：《World Journal of Hepatology》 (世界肝病学杂志（英文版）（电子版）)

年 卷 期：2024年第16卷第2期

页      面：115-119页

学科分类：1007[医学-药学(可授医学、理学学位)] 1002[医学-临床医学] 100204[医学-神经病学] 10[医学] 

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 

主　　题：Rifaximin discontinuation Hepatic encephalopathy Broad-spectrum antibiotics Crit-ically ill Medical intensive care unit Pharmacist-driven protocol 

摘      要：Hepatic encephalopathy(HE)is a formidable complication in patients with decompensated cirrhosis,often necessitating the administration of rifaximin(RFX)for effective ***,is a gut-restricted,poorly-absorbable oral rifamycin derived antibiotic that can be used in addition to lactulose for the secondary prophylaxis of *** has shown notable reductions in infection,hospital readmission,duration of hospital stay,and ***,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 *** 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 *** 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 ***,rates of other secondary clinical and safety outcomes,including ICU mortality and 48-hour changes in vasopressor requirements,were ***,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 ***,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 *** studies prompt further discussion about