Abstract

Dr. Muhammad Sharief*, Dr. Imran Ali and Dr. Aaima Bakhtawar

ABSTRACT

Background: Hepatic encephalopathy is the second most common major complication in cirrhotic patients and it significantly impacts quality of life. Medicinal approaches for hepatic encephalopathy treatment and prevention mainly depends on ammonia-lowering strategies and non-absorbable disaccharides are currently considered the cornerstone therapy. Non-absorbable antibiotics, such as neomycin and paramycin, are effective in treatment of acute hepatic encephalopathy episodes but their prolonged use has serious side-effects. To overcome these limitations, rifaximin use has been proposed. Objective: To determine the efficacy of rifaximin in cases of chronic liver disease presenting with hepatic encephalopathy. Methodology: In this descriptive cases series study, which was conducted at Department of Medicine, Nishtar Hospital Multan from May 2017 to October 2017 for 6 months period. The cases of both genders with age range of 25–70 years, having CLD (Child Pugh Class B & C) and acute hepatic encephalopathy of grade II or more irrespective of the cause were included in this study. Hepatic encephalopathy was labeled according to the West Haven Criteria. The cases of hepatic encephalopathy were given Rifaximin in a dose of 550 thrice a day for 7 days and complete resolution of hepatic encephalopathy at 7th day was labeled as positive efficacy. Data was analyzed by using SPSS 20. Results: In this study, there were total 254 cases out of which 144 (56.6%) were males and 110 (43.33%) females. There were 104 cases in Child Pugh class B and 150 cases in Child Pugh class C. Efficacy of rifaximin was seen in 129 (50.7%) cases. The efficacy was significantly high in cases that had Child Pugh Class B. Efficacy was also significantly better in grade II encephalopathy 62/86 cases in contrast to 53/71 cases with grade III. Conclusion: Rifaximin is good antibiotic for gut flora but it relieves hepatic encephalopathy in only half of cases. It is significantly better in cases with Child pugh class B and with encephalopathy grade III.