ABSTRACT
Background: Hepatic encephalopathy [HE] is among the commonest complications to present in the medical emergencies due to chronic liver disease [CLD]. Multiple regimens have been tried and newer antibiotic like Rifaximin is under extensive discussion regarding its management. Objective: To determine the efficacy of rifaximin in cases of chronic liver disease presenting with hepatic encephalopathy
Methodology: In this descriptive cases series study, which was conducted at Department of Medicine, Services Hospital, Lahore from 1st July to 31st December 2016. The cases of both genders with age range of 30-70 years, having CLD [Child Pugh Class B and C] and acute hepatic encephalopathy of grade II or more irrespective of the cause were included in this study. The cases with other co morbid conditions like DM, hypertension, renal or cardiac failure and those taking sedative, were excluded from this study. Hepatic encephalopathy was labeled according to the West Haven Criteria. The cases of HE were given Rifaximin in a dose of 550 thrice a day for 7 days and complete resolution of hepatic encephalopathy at 7th day was labeled as positive efficacy. Data was analyzed by using SPSS 20
Results: In this study, there were total 300 cases out of which 170 [56.67%] were males and 130 [43.33%] females. There were 150 cases in each child pugh class B and C and 114 [38%] cases had grade IV hepatic encephalopathy. Efficacy of rifaxamin was seen in 164 [45.33%] cases. The efficacy was significantly high in cases that had Child Pugh Class B where it was seen in 104 [69.33%] cases as compared to 60 [40%] in class C with p value of 0.03. Efficacy was also significantly better in grade III encephalopathy 70 [72.91%] cases in contrast to 34 [29.82%] cases with grade IV with p= 0.001
Conclusion: Rifaximin is good antibiotic for gut flora but it relieves hepatic encephalopathy in only half of cases. It is significantly better in cases with Child pugh class B and with encephalopathy grade III