Author information
Collaborators
Liverhope Consortium:
Adrià Juanola, Laura Napoleone, Marta Carol, Emma Avitabile, Ann Ma Thu, Marta Cervera, Martina Pérez, Ana Belén Rubio-Garcia, Alicia Ardiaca, Adriana Vives, Judit Pich, Núria Fabrellas, Giacomo Zaccherini, Maria Teresa Chiappa, César Jiménez, Ester Palacio, Daniela Campion, Tommaso Lanzillotti, Salvatore Piano, Gea Nicolao, Frank Uschner, Sabine Graf Dirmeier, Claire Francoz, Olivier Roux, Vanessa Esnault, Jeltje Helder, Marites Aban, Konstantin Kazankov, Marko Korenjak, Patrick Kamath, Juan G Abraldes, Hugh Watson
Affiliations
1University of Bologna, University Hospital S. Orsola-Malpighi di Bologna, Bologna, Italy.
2Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, CIEREHD, Barcelona, Catalonia, Spain.
3Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBEReHD, Barcelona, Catalonia, Spain.
4Division of Gastroenterology and Hepatology, Città della Salute e della Scienza Hospital, University of Torino, Turin, Italy.
5Amsterdam University Medical Centers, Amsterdam, the Netherlands.
6Goethe-University - Frankfurt am Main, Frankfurt am Main, Germany.
7EF-CLIF, Barcelona, Catalonia, Spain.
8University Hospital of Padova, Padova, Italy.
9Royal Free Hospital, University College London, London, United Kingdom.
10Hospital Beaujon, APHP, Paris, France.
11Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.
12Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
13Virginia Commonwealth University Medical Center, Richmond, VA.
Abstract
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.