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

World Journal of Hepatology 2024年第2期16卷 115-119页

作者： Chien-Hao Huang piero amodio Division of Hepatology Department of Gastroenterology and HepatologyChang-Gung Memorial HospitalLinkou Medical CenterTaoyuan 333Taiwan Department of Clinical and Experimental Medicine University of PaduaPadova 35122Italy

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

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

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Covert hepatic encephalopathy: Agreement and predictive validity of different indices

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World Journal of Gastroenterology 2014年第42期20卷 15756-15762页

作者： Sara Montagnese Esmeralda Balistreri Sami Schiff Michele De Rui Paolo Angeli Giacomo Zanus Umberto Cillo Giancarlo Bombonato Massimo Bolognesi David Sacerdoti Angelo Gatta Carlo Merkel piero amodio Department of Medicine University of Padova Department of Surgical Oncological and Gastroenterological Sciences University of Padova

AIM: To investigate the agreement and prognostic value of different measures of covert hepatic encephalopathy (CHE).

关键词： Hepatic encephalopathy Electroencephalography Psychometry Ammonia Liver cirrhosis

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Hepatitis C virus infection and health-related quality of life

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World Journal of Gastroenterology 2012年第19期18卷 2295-2299页

作者： piero amodio Laura Salari Sara Montagnese Sami Schiff Daniele Neri Tonino Bianco Lina Minazzato Department of Medicine University Hospital of Padua35128 PadovaItaly Unit of Algology University Hospital of Padua35128 PadovaItaly Unit of Hepatobiliary Surgery University Hospital of Padua35128 PadovaItaly

Hepatitis C virus(HCV) hepatitis and other diseases related to HCV,such as cryoglobulinemia,lymphoma and renal failure,impair health-related quality of life(HRQoL).In addition,HCV per se might directly influence HRQoL via colonization of microglia in the brain or,indirectly,via the effect of systemic inflammatory cytokines which,in turn,can trigger brain interleukin *** treatment of HCV-related disorders with interferon(IFN) has an effect on ***,IFN causes a transient deterioration of HRQoL,due to the induction of depression and other side effects of ***,the subjects who obtain a sustained virologic response experience an improvement in *** rarely does interferon treatment causes permanent detrimental effects on HRQoL,due to residual psychiatric or neurologic side *** transplantation is the only treatment for end-stage HCV-related liver *** generally improves massively a few months after transplantation,except in the case of serious complications of the transplant ***,high levels of anxiety and neuroticism pre-transplant are associated with lower HRQoL one year after ***,six months after transplant,patients with HCV who experience virologic recurrence show significantly greater depression,anxiety,phobic anxiety,and paranoid ideation than anti-HCV-negative *** conclusion,optimal care for the overall well-being of patients with HCV infection requires adequate knowledge of their neurological and psychological status.

关键词： Hepatitis C virus Quality of life Transplan-tation Hepatitis Cirrhosis

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