Adding rifaximin to lactulose treatment for acute hepatic encephalopathy did not shorten hospital length of stay but it did lower readmission rates at 180 days, study authors reported in a study published in the Journal of Pharmacy Practice

Rifaximin, a rifamycin, is indicated to reduce the recurrence of hepatic encephalopathy in patients with chronic liver disease. Not many studies, however, have studied the benefit of adding rifaximin to lactulose for the treatment of acute hepatic encephalopathy. Alesa Courson, PharmD, from the New York Presbyterian Hospital, New York, NY, and coauthors conducted a retrospective study of adult patients admitted between 2007–2012 within the Methodist LeBonheur Healthcare (MLH) System. Included patients were identified via the ICD-9 coding for liver cirrhosis. 

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Half of the 173 patients included received lactulose monotherapy, 36% received combination therapy, and 14% underwent therapy escalation. The median length of stay was 6 days in the monotherapy group vs. 8 days in the combination group (P=0.9). At Day 180, patients in the combination therapy group had fewer readmissions for hepatic encephalopathy than those receiving monotherapy (2.4% vs. 16.2%; P=0.02). 

Based on the study’s findings, Dr. Courson concluded that lactulose plus rifaximin decreased lower readmission rates at 180 days but did not reduce the hospital length of stay.

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