Comparison of once a day rifaximin to twice a day dosage in the prevention of recurrence of hepatic encephalopathy in patients with chronic liver disease

Background Rifaximin has been used for prevention of recurrence of hepatic encephalopathy in twice a day dosage. The drug is expensive and lower dising may be possible. Objective To determine the efficacy of rifaximin once a day dose in the prevention of hepatic encephalopathy ( HE ) in patients with liver cirrhosis as compared with twice daily dose of rifaximin. Methods This R andomized control trial was carried out at the D epartment of G astroenterology and H epatology, S hifa I nternational H ospital, I slamabad, P akistan from N ovember 2012 to F ebruary 2014. Patients with known chronic liver disease with at least one episode of HE in the past were randomized to group A (rifaximin 550 mg OD ) and group B (rifaximin 550 mg BD ), after fulfilling the inclusion criteria. Each patient was followed for 6 months for any episode of HE . Patients in each group were identified for any breakthrough episode of encephalopathy during this period. Data were analyzed using SPSS version 16. Chi‐squared test and t ‐test were applied where required to determine the significant difference between the two groups. Results There were a total of 306 patients: 128 patients in Group A while 178 in group B. Majority of patients (75.81%) had hepatitis C virus with mean age of 52.30 ± 9.92, MELD score 13.58 ± 8.3, and 55.22% were in Child–Pugh B. Eighty‐one patients had an episode of HE during the study period. There were 27 patients in group A and 54 patients in group B with breakthrough episode of HE ( P =  0.088). Conclusion This study suggests that there is no significant difference in rifaximin once a day or twice daily dose in preventing HE .