The Antibiotic Rifaximin Improves Hepatic Encephalopathy Symptoms in Patients With Cirrhosis Due to Hepatitis C

Oral rifaximin is a nonabsorbed antibiotic with broad-spectrum antimicrobial activity. Rifaximin 400 mg 3 times daily for 14 days was prospectively investigated in an outpatient setting for the treatment of mild hepatic encephalopathy (HE) in patients with cirrhosis due to hepatitis C virus (HCV). Patients were assessed 24 hours before and 14 days posttreatment. Thirty-seven consecutive patients were treated. Twenty-three patients were receiving pegylated interferon (IFN) plus ribavirin, and 12 patients had type 2 diabetes mellitus (DM). Overall, rifaximin improved HE symptoms and lowered serum ammonia to normal levels. Rifaximin was well tolerated, and no hypo/hyperglycemic episodes were reported. Because systemic antibiotics are associated with nephrotoxicity, and lactulose administration in DM patients is not ideal, rifaximin may be a more appropriate treatment for DM patients. Hepatic encephalopathy symptoms can be mistaken for pegylated IFN plus ribavirin adverse effects, and patients treated with these medications should be periodically evaluated for HE.