Shafique Ahmed, Shahzad Ahmad, Sami Ullah Khan.
Lactulose alone versus Lactulose + Rifaximin for the management of Hepatic Encephalopathy.
Pak J Med Health Sci Jan ;12(3):1269-71.

Aim: To compare the of lactulose plus rifaximin with efficacy of lactulose alone in the management of hepatic encephalopathy (HE). Methods: All the patients presenting with hepatic encephalopathy secondary to decompensated chronic liver disease (DCLD) were enrolled in the study. Patients were randomized into two groups; A and B, via lottery method. Those in group A received lactulose 30 ml thrice daily whilst those in group B were given lactulose 30 ml thrice daily plus rifaximin 550 mg twice daily. Patients were followed-up on day to day basis for a period of 3 days. Primary outcome was efficacy; defined as the the percentage of patients who underwent reversal of HE. All the data was recorded on a pre-designed proforma and analyzed by SPSS version 23.0. Chi square test was applied to compare the efficacy taking p value < 0.05 as statistically significant.Results: The two groups were comparable in terms of baseline characteristics such as mean age (p value = 0.63), gender (p value = 0.71), child class (p value = 0.74) and grade of HE (p value = 0.66). Lactulose alone (Group A) was found to be efficacious in 53.3% (32 out of 60) of the cases whilst 83.3% (50 out of 60) of the patients achieved reversal of HE in group B (Lactulose + Rifaximin group). The difference seen was statistically significant (p value = 0.0004). Conclusion: The combination of Rifaximin and lactulose was superior to lactulose alone in achieving reversal of hepatic encephalopathy.

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