Efficacy of rifaximin versus lactulose for reducing the recurrence of overt hepatic encephalopathy and hopitalizations in cirrhosis.

Both rifaximin and lactulose have been reported to be effective for maintenance of remission from hepatic encephalopathy (HE) in patients with cirrhosis. The aim of this study was to compare the efficacy of different treatment strategies for preventing recurrences and HE-related hospitalizations. Seventy-eight cirrhotic patients who recovered from HE were grouped according to one of the following therapies: rifaximin intermittently 14 days/month (RI- group), rifaximin 400 mg three times daily (RD-group) and lactulose 30 to 60 ml in 2 or 3 divided doses daily (L-group) for a 6-month period. The follow-up lasted 12 months. A Kaplan-Meier analysis was performed to determine the probability of developing recurrent overt HE episodes. The frequencies of HE- related hospitalizations in the three groups were evaluated comparatively. Over a 12-month follow-up period, 10 (26.31 %) of 38 patients in the RI-group, 7 (25%) of 28 in the RD-group and 4 (33.33 %) of 12 in the L-group experienced recurrent bouts of HE, the differences not being significant. More L-group patients experienced more severe episodes of overt HE in spite of mild or moderate disease. In the rifaximin groups overt HE episodes were similarly frequent, and the severity of bouts was associated with Child-Pugh score. Fewer hospitalizations were reported in the rifaximin groups. According to our data, rifaximin and lactulose are equally effective for the maintenance of remission from overt HE. However, rifaximin is superior for reducing the risk of HE-related hospitalization.