In this trial of 299 patients with chronic liver disease and recurrent hepatic encephalopathy (in remission), they were randomized to rifaximin (550mg BID) or placebo for 6 months (>90% also received concomitant lactulose). The rifaximin group had significantly reduced risk of recurrence of hepatic encephalopathy (Hazard Ratio 0.42, CI 0.28-0.64), occurring in 22% of the rifaximin group and 46% of the placebo group. Risk of hospitalization associated with encephalopathy was also significantly less in the rifaximin group (14% vs 23%). Adverse events were similar between the groups. The risk of recurrent encephalopathy and hospitalizations can be reduced with rifaximin (abstract), however, cost is an issue, as 600mg BID would cost > $1,000/month (drugstore.com)
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