Table 4.
Antibiotics therapies for hepatic encephalopathy.
| Author | Scheme | Group | Result | Ref. |
|---|---|---|---|---|
| Kang et al., 2017 | A retrospective cohort study | Rifaximin + lactulose or lactulose in non-HCC cohort or HCC cohort | In the non-HCC cohort, rifaximin was significantly associated with a lower risk of death and reduced the risk of recurrent HE, spontaneous bacterial peritonitis. In the HCC cohort, rifaximin was not associated with a risk of death. It was associated with a lower risk of spontaneous bacterial peritonitis but not with varicose bleeding or recurrent HE. The risk of Clostridium difficile-associated diarrhea was not different between the two groups. |
[85] |
| Kaji et al., 2017 | A clinical trial | 20 patients with decompensated cirrhosis (Child–Pugh score > 7) | Treatment with rifaximin for 4 weeks resulted in a decrease in endotoxin activity and serum ammonia levels. Treatment with rifaximin for 4 weeks resulted in a decrease in endotoxin activity and serum ammonia levels. There was no significant difference in the diversity and composition of gut microbiota at baseline and after 4 weeks of treatment but the relative abundance of genus Veillonella and Streptococcus was lowered. |
[86] |
| Bajaj et al., 2013 | A clinical trial | 20 patients with cirrhosis who had been diagnosed with MHE | There was a significant cognitive improvement and a decrease in endotoxemia after rifaximin treatment. Serum saturated and unsaturated fatty acids were significantly increased after rifaximin treatment. No significant changes in gut microbiota were observed except for the decrease of Veillonellaceae and the increase of Eubacteriaceae. | [87] |
| Zuo et al., 2017 | A randomized clinical trial | Rifaximin or rifaximin and probiotics in cirrhotic patients with MHE | Both treatments reduced overall microbiome diversity and decreased abundance of specific ammonia-producing bacteria. The treatment with rifaximin + probiotics showed a more definite effect. Patients with nonalcoholic MHE were more responsive to microbiota alteration therapy. | [88] |
| Suzuki et al., 2018 Kawaguchi et al., 2019 |
A prospective, randomized studies (a phase II/III study and a phase III study) | Rifaximin or lactitol with grade I or II HE and hyperammonemia patients | Blood ammonia concentrations were significantly improved in the rifaximin group. The portal systemic encephalopathy index was significantly improved in both groups. As a result of fecal microbiome analysis of 17 participants in the clinical trial, the number of Streptococcus, Veillonella and Lactobacillus decreased after rifaximin treatment. Rifaximin alters the composition of microbial taxa linked to hepatic/neuropsychological function. |
[89,90] |
| Schulz et al., 2019 | A randomized clinical trial | Rifaximin or rifaximin and lactulose in cirrhotic patients with MHE | An improvement in MHE was confirmed after treatment. Microbiological analysis was performed on duodenum and stool samples and no statistically significant changes were found in the bacterial profile. Rifaximin therapy with or without lactulose for 3 months has no effect on microbiome composition. HE improvement with rifaximin persisted after termination. | [91] |
HCC, hepatocellular carcinoma; and MHE, minimal hepatic encephalopathy.