Antibiotics for the treatment of hepatic encephalopathy
Open accessAbstract
The treatment of hepatic encephalopathy (HE) is complex and therapeutic regimens vary according to the acuity of presentation and the goals of therapy. Most treatments for HE rely on manipulating the intestinal milieu and therefore antibiotics that act on the gut form a key treatment strategy. Prominent antibiotics studied in HE are neomycin, metronidazole, vancomycin and rifaximin. For the management of the acute episode, all antibiotics have been tested. However the limited numbers studied, adverse effects (neomycin oto- and nephrotoxicity, metronidazole neurotoxicity) and potential for resistance emergence (vancomycin-resistant enterococcus) has limited the use of most antibiotics, apart from rifaximin which has the greatest evidence base. Rifaximin has also demonstrated, in conjunction with lactulose, to prevent overt HE recurrence in a multi-center, randomized trial. Despite its cost in the US, rifaximin may prove cost-saving by preventing hospitalizations for overt HE. In minimal/covert HE, rifaximin is the only systematically studied antibiotic. Rifaximin showed improvement in cognition, inflammation, quality-of-life and driving simulator performance but cost-analysis does not favor its use at the current time. Antibiotics, especially rifaximin, have a definite role in the management across the spectrum of HE.
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Cognitive impairment arising due to hepatic encephalopathy is mediated by microbial disturbances and can be reversed with oral antibiotic treatment.
“For example, it is well established that the cognitive impairment arising due to hepatic encephalopathy is mediated by microbial disturbances and can be reversed with oral antibiotic treatment (414–417).”
From Signalling cognition: The gut microbiota and hypothalamic-pituitary-adrenal axis (2023) · cites this paper as [415]
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- Authors
- Patidar, K. R., & Bajaj, J. S.
- Affiliations
- Virginia Commonwealth University (US)
- Corresponding author
- Bajaj, Jasmohan S.
- Venue
- Metabolic Brain Disease
- Published
- 2013-02-08
- Volume
- 28
- Issue
- 2
- Pages
- 307-312
- ISSN
- 0885-7490 (ISSN-L)
- 1573-7365
- PMC
- PMC3654040
- OpenAlex
- W2113992770
- Cited by
- 110
- References
- 47
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 6 · 2023: 11 · 2022: 8 · 2021: 12 · 2020: 7 · 2019: 10 · 2018: 9 · 2017: 8 · 2016: 9 · 2015: 11 · 2014: 8 · 2013: 2
- FWCI
- 1.27
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Metabolic Brain Disease (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR000058)
- National Institute on Alcohol Abuse and Alcoholism (R01AA020203)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK087913)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Neurology › Alcoholism and Thiamine Deficiency
- Keywords
- hepatic encephalopathy, rifaximin, neomycin, metronidazole, vancomycin, lactulose, antibiotic adverse effects, antibiotic resistance, covert hepatic encephalopathy, cost-effectiveness, liver disease
- MeSH terms
- Aminoglycosides, Anti-Bacterial Agents, Hepatic Encephalopathy, Humans, Infections
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