Review
Copyright ©The Author(s) 2015.
World J Gastroenterol. Nov 21, 2015; 21(43): 12322-12333
Published online Nov 21, 2015. doi: 10.3748/wjg.v21.i43.12322
Table 3 Available studies describing the effects of rifaximin on endotoxemia in patients with advanced liver disease
StudyStudy designNo. patientsDisease severityTreatment scheduleResultsSafety
Vlachogiannakos et al[71] 2009Prospective30welve patients (40%) were Child-Pugh B and 18 (60%) Child-Pugh CRifaximin 1200 mg/d for 28 dMedian (range) plasma endotoxin levels decreased significantly after rifaximin administration both in systemic [1.45 (0-3.1) vs 0.7 (0-2.7), P < 0.0001] and splanchnic circulation [1.8 (0-3.4) vs 0.8 (0-2.1), P < 0.0001]. Meanwhile, the difference seen in endotoxin levels between the splanchnic and systemic circulation at day 0 (P = 0.001) was not noted at day 29 (P = 0.137)Abdominal pain: 3%
CTP score: A: 0%, B: 40%, C: 60%Self-limited diarrhea: 3%
MELD score (mean, range): 17 (11-27)Reduction in endotoxin levels in both systemic and splanchnic circulation compared to baseline (P < 0.0001)
B: 40%, C: 60%Reduction in HVPG compared to baseline (P < 0.0001)
Reduction in HVPG correlated with hepatic vein endotoxin values (P = 0.023)
Kalambokis et al[73] 2012Prospective9CTP score: B: 56%, C: 44%8-wk course of rifaximin (1200 mg/d)Rifaximin significantly reduced plasma endotoxin levelsNot reported
Rifaximin 1200 mg/d for 8 wkReduction in plasma endotoxin levels compared to baseline (P < 0.01)
Vlachogiannakos et al[72] 2012Prospective69welve patients (40%) were Child-Pugh B and 18 (60%) Child-Pugh C23 pts who achieved a decrease in HVPG after 28-d rifaximin treatment[71]Median (range) plasma endotoxin levels decreased significantly after rifaximin administration both in systemic [1.45 (0-3.1) vs 0.7 (0-2.7), P < 0.0001] and splanchnic circulation [1.8 (0-3.4) vs 0.8 (0-2.1), P < 0.0001]. Meanwhile, the difference seen in endotoxin levels between the splanchnic and systemic circulation at day 0 (P = 0.001) was not noted at day 29 (P = 0.137)Nausea: 9%
Self-limited rash in the extremities: 4%
Persistent diarrhea: 4%
CTP score46 cirrhotic controls
rifaximinReduction in plasma endotoxin levels in both systemic and splanchnic circulation compared to baseline (P < 0.0001)
A: 0%, B: 48%, C: 52%
controls:Risk of developing variceal bleeding: 35% rifaximin vs 59.5% controls (P = 0.011)
A: 0%, B: 48%, C: 52%Incidence of HE: 31.5% rifaximin vs 47% controls (P = 0.034)
MELD score (mean ± SD)Incidence of SBP: 4.5% rifaximin vs 46% controls (P = 0.027)
rifaximin: 17.2 ± 3.6Incidence of HRS: 4.5% rifaximin vs 51% controls (P = 0.037)
controls: 16.6 ± 3.5
Kalambokis et al[75] 2012Prospective, randomized, placebo-controlled23CTP score13 pts: rifaximin 1200 mg/d for 4 wkReduction in endotoxin levels compared to control group (P = 0.005)Not reported
rifaximin:Increase in mean platelets count in rifaximin group compared to controls (P = 0.006)
A: 0%, B: 46%, C: 54%
placebo:10 cirrhotic pts: placebo
A: 0%, B: 40%, C: 60%
Bajaj et al[62] 2013Prospective20MELD score (mean ± SD): 9.8 ± 3.3Rifaximin 550 mg BID for 8 wkReduction in plasma endotoxin levels compared to baseline (P = 0.02)Not reported