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The Use of Rifaximin in Patients With Cirrhosis

Rifaximin is an oral nonsystemic antibiotic with minimal gastrointestinal absorption and broad‐spectrum antibacterial activity covering both gram‐positive and gram‐negative organisms. Rifaximin is currently used worldwide in patients with cirrhosis for preventing recurrent HE because its efficacy an...

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Autores principales: Caraceni, Paolo, Vargas, Victor, Solà, Elsa, Alessandria, Carlo, de Wit, Koos, Trebicka, Jonel, Angeli, Paolo, Mookerjee, Rajeshwar P., Durand, François, Pose, Elisa, Krag, Aleksander, Bajaj, Jasmohan S., Beuers, Ulrich, Ginès, Pere
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8518409/
https://www.ncbi.nlm.nih.gov/pubmed/33421158
http://dx.doi.org/10.1002/hep.31708
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author Caraceni, Paolo
Vargas, Victor
Solà, Elsa
Alessandria, Carlo
de Wit, Koos
Trebicka, Jonel
Angeli, Paolo
Mookerjee, Rajeshwar P.
Durand, François
Pose, Elisa
Krag, Aleksander
Bajaj, Jasmohan S.
Beuers, Ulrich
Ginès, Pere
author_facet Caraceni, Paolo
Vargas, Victor
Solà, Elsa
Alessandria, Carlo
de Wit, Koos
Trebicka, Jonel
Angeli, Paolo
Mookerjee, Rajeshwar P.
Durand, François
Pose, Elisa
Krag, Aleksander
Bajaj, Jasmohan S.
Beuers, Ulrich
Ginès, Pere
author_sort Caraceni, Paolo
collection PubMed
description Rifaximin is an oral nonsystemic antibiotic with minimal gastrointestinal absorption and broad‐spectrum antibacterial activity covering both gram‐positive and gram‐negative organisms. Rifaximin is currently used worldwide in patients with cirrhosis for preventing recurrent HE because its efficacy and safety have been proven by large randomized clinical trials. In the last decade, experimental and clinical evidence suggest that rifaximin could have other beneficial effects on the course of cirrhosis by modulating the gut microbiome and affecting the gut‐liver axis, which in turn can interfere with major events of the pathophysiological cascade underlying decompensated cirrhosis, such as systemic inflammatory syndrome, portal hypertension, and bacterial infections. However, the use of rifaximin for prevention or treatment of other complications, including spontaneous bacterial peritonitis or other bacterial infections, is not accepted because evidence by clinical trials is still very weak. The present review deals in the first part with the potential impact of rifaximin on pathogenic mechanisms in liver diseases, whereas in the second part, its clinical effects are critically discussed. It clearly emerges that, because of its potential activity on multiple pathogenic events, the efficacy of rifaximin in the prevention or management of complications other than HE deserves to be investigated extensively. The results of double‐blinded, adequately powered randomized clinical trials assessing the effect of rifaximin, alone or in combination with other drugs, on hard clinical endpoints, such as decompensation of cirrhosis, acute‐on‐chronic liver failure, and mortality, are therefore eagerly awaited.
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spelling pubmed-85184092021-10-21 The Use of Rifaximin in Patients With Cirrhosis Caraceni, Paolo Vargas, Victor Solà, Elsa Alessandria, Carlo de Wit, Koos Trebicka, Jonel Angeli, Paolo Mookerjee, Rajeshwar P. Durand, François Pose, Elisa Krag, Aleksander Bajaj, Jasmohan S. Beuers, Ulrich Ginès, Pere Hepatology Reviews Rifaximin is an oral nonsystemic antibiotic with minimal gastrointestinal absorption and broad‐spectrum antibacterial activity covering both gram‐positive and gram‐negative organisms. Rifaximin is currently used worldwide in patients with cirrhosis for preventing recurrent HE because its efficacy and safety have been proven by large randomized clinical trials. In the last decade, experimental and clinical evidence suggest that rifaximin could have other beneficial effects on the course of cirrhosis by modulating the gut microbiome and affecting the gut‐liver axis, which in turn can interfere with major events of the pathophysiological cascade underlying decompensated cirrhosis, such as systemic inflammatory syndrome, portal hypertension, and bacterial infections. However, the use of rifaximin for prevention or treatment of other complications, including spontaneous bacterial peritonitis or other bacterial infections, is not accepted because evidence by clinical trials is still very weak. The present review deals in the first part with the potential impact of rifaximin on pathogenic mechanisms in liver diseases, whereas in the second part, its clinical effects are critically discussed. It clearly emerges that, because of its potential activity on multiple pathogenic events, the efficacy of rifaximin in the prevention or management of complications other than HE deserves to be investigated extensively. The results of double‐blinded, adequately powered randomized clinical trials assessing the effect of rifaximin, alone or in combination with other drugs, on hard clinical endpoints, such as decompensation of cirrhosis, acute‐on‐chronic liver failure, and mortality, are therefore eagerly awaited. John Wiley and Sons Inc. 2021-06-07 2021-09 /pmc/articles/PMC8518409/ /pubmed/33421158 http://dx.doi.org/10.1002/hep.31708 Text en © 2021 The Authors. Hepatology published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Reviews
Caraceni, Paolo
Vargas, Victor
Solà, Elsa
Alessandria, Carlo
de Wit, Koos
Trebicka, Jonel
Angeli, Paolo
Mookerjee, Rajeshwar P.
Durand, François
Pose, Elisa
Krag, Aleksander
Bajaj, Jasmohan S.
Beuers, Ulrich
Ginès, Pere
The Use of Rifaximin in Patients With Cirrhosis
title The Use of Rifaximin in Patients With Cirrhosis
title_full The Use of Rifaximin in Patients With Cirrhosis
title_fullStr The Use of Rifaximin in Patients With Cirrhosis
title_full_unstemmed The Use of Rifaximin in Patients With Cirrhosis
title_short The Use of Rifaximin in Patients With Cirrhosis
title_sort use of rifaximin in patients with cirrhosis
topic Reviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8518409/
https://www.ncbi.nlm.nih.gov/pubmed/33421158
http://dx.doi.org/10.1002/hep.31708
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