Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics.
This week: Rifamyxin
Liver disease affects more than two million Australians, two thousand Australians die each year from chronic liver diseases, including cirrhosis and cancer. Liver damage can result from high-fat diet, alcohol consumption, and viral hepatitis. One of the major causes of complications in this patient group is hepatic encephalopathy, a syndrome of neurological complications that can manifest as altered mental status, impaired sensory capabilities, and psychomotor problems and, in severe cases, coma.
- Hepatic encephalopathy is believed to arise in patients with liver disease due to a decreased ability to process and excrete gut-derived neurotoxins, principally ammonia. The current standard of care includes treatment with lactulose, which decreases the absorption of toxic amines and alters the pH of the gut. Lactulose can cause unpleasant side effects including flatulence, unpredictable diarrhoea, bloating, and a sweet taste in the mouth.
- Rifaximin is a broad-spectrum oral antibiotic that acts locally in the gut and has minimal systemic absorption from the GI tract. Its efficacy has been demonstrated in the treatment of acute hepatic encephalopathy episodes, & has a minimal side effect profile and low risk of bacterial resistance.
- Research suggests that four patients would need to be treated with rifaximin for six months to prevent one episode of symptomatic hepatic encephalopathy. The relative risk reduction for hospitalization due to hepatic encephalopathy was 50% with rifaximin compared to placebo. These results support the protective effect and valid place of rifaximin in the prevention and treatment of HE.
Please consider these issues when preparing or interpreting RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to firstname.lastname@example.org.