COMPARATIVE STUDY OF METRONIDAZOLE AND RIFAXIMIN IN PATIENTS WITH HEPATIC ENCEPHALOPATHY

S AZHAR; SI AHMED; A MUKHTAR; H AZHAR; A HASSAN; Z HASHIR

doi:10.54112/bcsrj.v2023i1.376

Authors

S AZHAR Department of General Medicine, Islamabad Medical and Dental College, Islamabad, Pakistan
SI AHMED Department of General Medicine, Islamabad Medical and Dental College, Islamabad, Pakistan
A MUKHTAR Gynaecology Department Railway General Hospital Rawalpindi, Pakistan
H AZHAR Department of Radiology, CMH Muzaffarabad, Pakistan
A HASSAN Department of Gastroenterology, Islamabad Medical and Dental College, Islamabad, Pakistan
Z HASHIR Department of General Medicine, Islamabad Medical and Dental College, Islamabad, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2023i1.376

Keywords:

Metronidazole, Rifaximin, Hepatic encephalopathy, Comparative study, Liver disease, Gastrointestinal disorder

Abstract

Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome due to liver brokenness, especially in patients with cirrhosis or intense liver failure. The study's main objective is to find the comparative effectiveness of metronidazole and rifaximin in patients with hepatic encephalopathy. This prospective comparative study was conducted at Islamabad Medical and Dental College, Islamabad, over six months, from January 2023 to July 2023. The study population consisted of adult patients (age 18 years and above) diagnosed with hepatic encephalopathy admitted to the hospital's medical wards or gastroenterology department during the study duration. Patients with a confirmed diagnosis of hepatic encephalopathy based on clinical and laboratory criteria were included in the study. Out of the 150 patients enrolled in the study, 75 were randomized to receive metronidazole (Group A) and 75 to receive rifaximin (Group B). All patients completed the 10-day treatment period, and there were no dropouts during the study. In Group A (metronidazole), 60 out of 75 patients (80%) showed improvement in hepatic encephalopathy based on the West Haven criteria. In Group B (rifaximin), 70 out of 75 patients (93.33%) showed improvement in hepatic encephalopathy based on the West Haven criteria. The improvement in hepatic encephalopathy was significantly higher in Group B (rifaximin) compared to Group A (metronidazole) (p < 0.05).

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References

Bajaj, J. S., Heuman, D. M., Wade, J. B., Gibson, D. P., Saeian, K., Wegelin, J. A., Hafeezullah, M., Bell, D. E., Sterling, R. K., and Stravitz, R. T. (2011). Rifaximin improves driving simulator performance in a randomized trial of patients with minimal hepatic encephalopathy. Gastroenterology 140, 478-487. e1.

Eltawil, K. M., Laryea, M., Peltekian, K., and Molinari, M. (2012). Rifaximin vs conventional oral therapy for hepatic encephalopathy: a meta-analysis. World journal of gastroenterology: WJG 18, 767.

Favier, R. P., de Graaf, E., Corbee, R. J., and Kummeling, A. (2020). Outcome of non-surgical dietary treatment with or without lactulose in dogs with congenital portosystemic shunts. Veterinary Quarterly 40, 108-114.

Flamm, S. L. (2018). Considerations for the cost-effective management of hepatic encephalopathy. Am J Manag Care 24, S51-S61.

Kawaratani, H., Kondo, Y., Tatsumi, R., Kawabe, N., Tanabe, N., Sakamaki, A., Okumoto, K., Uchida, Y., Endo, K., and Kawaguchi, T. (2022). Long-term efficacy and safety of rifaximin in Japanese patients with hepatic encephalopathy: A multicenter retrospective study. Journal of Clinical Medicine 11, 1571.

Malaguarnera, M., Gargante, M. P., Malaguarnera, G., Salmeri, M., Mastrojeni, S., Rampello, L., Pennisi, G., Volti, G. L., and Galvano, F. (2010). Bifidobacterium combined with fructo-oligosaccharide versus lactulose in the treatment of patients with hepatic encephalopathy. European journal of gastroenterology & hepatology 22, 199-206.

Mas, A., Rodés, J., Sunyer, L., Rodrigo, L. s., Planas, R., Vargas, V., Castells, L. s., Rodrı́guez-Martı́nez, D., Fernández-Rodrı́guez, C., and Coll, I. (2003). Comparison of rifaximin and lactitol in the treatment of acute hepatic encephalopathy: results of a randomized, double-blind, double-dummy, controlled clinical trial. Journal of hepatology 38, 51-58.

Mekky, M. A., Riad, A. R., Gaber, M. A., Abdel-Malek, M. O., and Swifee, Y. M. (2018). Rifaximin versus metronidazole in management of acute episode of hepatic encephalopathy: An open labeled randomized clinical trial. Arab journal of gastroenterology 19, 76-79.

Mohammad, R. A., Regal, R. E., and Alaniz, C. (2012). Combination therapy for the treatment and prevention of hepatic encephalopathy. Annals of Pharmacotherapy 46, 1559-1563.

Prasad, S., Dhiman, R. K., Duseja, A., Chawla, Y. K., Sharma, A., and Agarwal, R. (2007). Lactulose improves cognitive functions and health‐related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy. Hepatology 45, 549-559.

Riordan, S. M., Williams, R., Riordan, S., Williams, R., Sharma, B., Sharma, P., Agrawal, A., Sarin, S., Poordad, F., and Bustamante, J. (2010). Gut flora and hepatic encephalopathy in patients with cirrhosis. New England Journal of Medicine 362, 1140.

Schedule, A. Message from the Vice Chancellor i➢ Biochemistry 19 Message from the Director Evening Program. Computer Science 22, 23.

Sharma, B. C., Sharma, P., Lunia, M. K., Srivastava, S., Goyal, R., and Sarin, S. (2013). A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy. Official journal of the American College of Gastroenterology| ACG 108, 1458-1463.

Tapper, E. B., Jiang, Z. G., and Patwardhan, V. R. (2015). Refining the ammonia hypothesis: a physiology-driven approach to the treatment of hepatic encephalopathy. In "Mayo Clinic Proceedings", Vol. 90, pp. 646-658. Elsevier.