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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...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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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. |
format | Online Article Text |
id | pubmed-8518409 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
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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