A controlled study of intermittent and regular administration of rifaximin for the prevention of hepatic encephalopathy and all-cause hospitalisation

Abstract:

Objective To compare whether intermittent use of rifaximin in clinical practice is no less effective than regular dosing in preventing recurrence of hepatic encephalopathy（HE） and whether rifaximin treatment before and after reduces the number of patients hospitalized for HE and all-cause illness.Methods The study was a single-center prospective case-control study in which enrolled HE patients were divided into 2 groups according to different dosing regimens，with a minimum duration of 4 weeks，including intermittent dosing group（rifaximin 400 mg tid， 2 days a week），with 30 patients，18 of whom were treated for 3 months；regular dosing group （rifaximin 400 mg tid， daily），with 25 patients，24 of whom were treated for 3 months. The differences in HE and all-cause hospitalization between the two groups were compared at different dosing times and before and after dosing.Results There was no statistically significant difference in the probability of hospitalization for HE and all-cause hospitalization in the intermittent dosing group compared to the regular dosing group at 4 weeks of dosing（P>0.05）， and there was either no statistically significant difference in the number of hospitalizations for HE and all-cause hospitalization at 3 months of dosing（P>0.05）. The mean times of hospitalizations for HE ［（0.52±0.86） vs. （1.12±1.04），P=0.000］ and all-cause hospitalizations［（0.90±0.98） vs. （1.60±1.08），P=0.000］ were reduced in the 3 months following rifaximin administration compared to the 3 months prior to administration. Subgroup analysis revealed a statistically significant difference in the number of hospitalizations for he and all-cause hospitalizations in both the intermittent and regular dosing groups at 3 months after dosing compared to 3 months before dosing（P<0.05）. Patients in the regular dosing group had a higher proportion of stools containing fungi（4/7 vs. 1/10），but the difference was not statistically significant（P=0.101）.Conclusion Intermittent use of rifaximin for the prevention of HE is non-inferior to regular use. Both intermittent and regular use of rifaximin can reduce the number of patients hospitalized for HE and all-cause hospitalization after dosing. Long-term use in the clinic requires caution about the risk of fungal infection.