The Use of Rifaximin in Patients With Cirrhosis
Caraceni, Paolo (University Hospital S. Orsola-Malpighi di Bologna)
Vargas, Victor (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Solà, Elsa (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Alessandria, Carlo (University of Torino)
de Wit, Koos (Amsterdam UMC. University Medical Center)
Trebicka, Jonel (EF-CLIF (Barcelona))
Angeli, Paolo (University Hospital of Padova (Pàdua, Itàlia))
Mookerjee, Rajeshwar P. (University College London)
Durand, François (Hospital Beaujon)
Pose, Elisa (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Krag, Aleksander (University of Southern Denmark)
Bajaj, Jasmohan S. (Virginia Commonwealth University Medical Center)
Beuers, Ulrich (Amsterdam UMC. University Medical Center)
Ginès, Pere (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Universitat Autònoma de Barcelona

Data:	2021
Resum:	Rifaximin is an oral nonsystemic antibiotic with minimal gastrointestinal absorption and broad-spectrum antibacterial activity covering both gram-positive and gram-negative organisms. Rifaximin is currently used worldwide in patients with cirrhosis for preventing recurrent HE because its efficacy and safety have been proven by large randomized clinical trials. In the last decade, experimental and clinical evidence suggest that rifaximin could have other beneficial effects on the course of cirrhosis by modulating the gut microbiome and affecting the gut-liver axis, which in turn can interfere with major events of the pathophysiological cascade underlying decompensated cirrhosis, such as systemic inflammatory syndrome, portal hypertension, and bacterial infections. However, the use of rifaximin for prevention or treatment of other complications, including spontaneous bacterial peritonitis or other bacterial infections, is not accepted because evidence by clinical trials is still very weak. The present review deals in the first part with the potential impact of rifaximin on pathogenic mechanisms in liver diseases, whereas in the second part, its clinical effects are critically discussed. It clearly emerges that, because of its potential activity on multiple pathogenic events, the efficacy of rifaximin in the prevention or management of complications other than HE deserves to be investigated extensively. The results of double-blinded, adequately powered randomized clinical trials assessing the effect of rifaximin, alone or in combination with other drugs, on hard clinical endpoints, such as decompensation of cirrhosis, acute-on-chronic liver failure, and mortality, are therefore eagerly awaited.
Ajuts:	Agència de Gestió d'Ajuts Universitaris i de Recerca 2017SGR-01281 Ministerio de Economía y Competitividad PI16/00043 Instituto de Salud Carlos III PI18/00727 Instituto de Salud Carlos III PI20/00529 European Commission 731875
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	Hepatology, Vol. 74 (june 2021) , p. 1660-1673, ISSN 1527-3350

DOI: 10.1002/hep.31708
PMID: 33421158

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