In vitro antimicrobial activity of rifaximin against enteropathogens causing traveler's diarrhea

The in vitro activity of rifaximin against 84 diarrheagenic Escherichia coli and 11 Shigella sonnei causing traveler's diarrhea was evaluated. The MIC of rifaximin ranged between <0.007 and 32 mg/L; other agents tested had an MIC of >256 mg/L in most cases. The results showed the potential use of rifaximin to treat these infections.     

利福昔明片多中心、随机、单盲对照治疗急性细菌感染性腹泻的临床疗效观察

目的　评价国产利福昔明治疗细菌感染性腹泻的疗效和安全性。方法　采用多中心、随机、单盲对照试验 ,以国产环丙沙星作对照 ,研究利福昔明治疗细菌感染性腹泻的效果。利福昔明第一日每次 0 .4 g,一日三次 ,第二日起每日 0 .4 g,一日二次 ;环丙沙星第一日每次 0 .2 5 g,一日三次 ,第二日起每次 0 .2 5 g,一日二次 ,疗程均为 3～ 7d。治疗前、后查血、尿、大便常规 ,肝、肾功能和血生化 ,心电图用于安全性评价。结果　利福昔明组 10 0例 ,环丙沙星组 10 5例 ,其临床有效率和临床痊愈率分别为 10 0 %和 93.0 0 % ,98.0 9%和 92 .38% ,两组临床有效率和痊愈率无统计学差异。 2 0 5例中有 137例治疗前分离到病原菌 ,细菌阳性率 6 6 .83%( 137/ 2 0 5 )。细菌清除率分别为 10 0 % ,97.10 %。两组不良反应发生率分别为 10 .4 8%和 5 .36 % ( 6 / 112 ) ,经统计学处理无显著性差异。结论　利福昔明片治疗细菌感染性腹泻 ,临床疗效肯定 ,不良反应少 ,可在细菌感染性腹泻治疗中应用     

Hospitalizations During the Use of Rifaximin Versus Lactulose for the Treatment of Hepatic Encephalopathy

We sought to compare frequency and duration of hepatic encephalopathy-related hospitalizations during rifaximin versus lactulose treatment. Hospitalizations, clinical efficacy data, and adverse events obtained from charts of 145 patients with hepatic encephalopathy who received lactulose (30 cc twice daily) for ≥6 months and then rifaximin (400 mg 3 times a day) for ≥6 months compared last 6 months on lactulose (lactulose period) to first 6 months on rifaximin (rifaximin period). Fewer hospitalizations (0.5 versus 1.6; P < .001), fewer days hospitalized (2.5 versus 7.3; P < .001), fewer total weeks hospitalized (0.4 versus 1.8; P < .001), and lower hospitalization charges per patient ($14,222 versus $56,635) were reported during the rifaximin period. More patients had asterixis, diarrhea, flatulence, and abdominal pain during the lactulose period (P < .001). Treatment of hepatic encephalopathy with rifaximin was associated with lower hospitalization frequency and duration, lower hospital charges, better clinical status, and fewer adverse events.     

国产利福昔明与环丙沙星治疗细菌性肠道感染的成本-效果分析

目的：评价国产利福昔明与环丙沙星治疗细菌性肠道感染的成本-效果。方法：采用循证医学方法收集国产利福昔明与环丙沙星治疗细菌性肠道感染的临床资料,应用药物经济学的最小成本分析法及成本-效果分析法进行分析。结果：国产利福昔明与环丙沙星治疗细菌性肠道感染有效率分别为97．14％（746／768）、97．19％（761／783）（P〉0．05）;成本-效果比分别为151与9．25。结论：环丙沙星治疗细菌性肠道感染更经济。     

Risk factors for candidaemia in hospitalized patients with liver cirrhosis: a multicentre case–control–control study

ObjectivesThe aim of this study was to evaluate the risk factors for candidaemia in patients with liver cirrhosis.MethodsThis was a case–control–control (1:2:2) study performed in four Italian tertiary centres from 2006 to 2015. Cases were patients with liver cirrhosis developing candidaemia. For every case of candidaemia we enrolled two additional patients undergoing blood cultures for suspected infection yielding isolation of a bacterial pathogen (control A) and two additional patients undergoing blood cultures for suspected infection yielding negative results (control B). Patients were matched according to age, sex and model for end stage liver disease at hospital admission.ResultsDuring the study period 90 cases, 180 controls A and 180 controls B were included. At multivariate analysis assessed by means of multinomial conditional regression models, factors independently associated with candidaemia were previous (<30 days) acute-on-chronic liver failure (relative risk ratio (RRR) 2.22 (95% confidence interval (CI) 1.09–4.54), p = 0.046), previous(<30 days) gastrointestinal endoscopy (RRR 2.38 (95% CI 1.19–4.78) p = 0.014), previous(<30 days) antibiotic treatment for at least 7 days (RRR 2.74 (95% CI 1.00–7.48), p = 0.049), presence of central venous catheter (RRR 2.77 (95% CI 1.26–6.09, p = 0.011), total parenteral nutrition (RRR 3.90 (95% CI 1.62–9.40), p = 0.002) at infection onset and length of in-hospital stay >15 days (RRR 4.63 (95% CI 2.11–10.18), p <0.001] Conversely, rifaximin treatment was associated with lower rate of candidaemia (RRR 0.38 (95% CI 0.19–0.77), p = 0.007). Multivariable analysis for 30-day mortality showed that patients with isolation of Candida spp. from blood cultures had worse outcome when compared with controls even though the difference did not reach a statistical significance (hazard ratio 1.64 (95% 0.97–2.75) p = 0.06).ConclusionsWe identified previous antibiotic use, gastrointestinal endoscopy or acute-on-chronic liver failure and presence of central venous catheter especially for parenteral nutrition as independent factors associated with candidaemia. Surprisingly, chronic rifaximin use was a protective factor.     

Rifaximin Plus Levofloxacin-Based Rescue Regimen for the Eradication of Helicobacter pylori

Background/Aims

This study assessed the efficacy of a rifaximin plus levofloxacin-based rescue regimen in patients that had failed both triple and quadruple standard regimens for the eradication of Helicobacter pylori.

Methods

We treated patients for H. pylori between August 2009 and April 2011. The triple regimen consisted of combined treatment with amoxicillin, clarithromycin, and pantoprazole for 1 week. For failed cases, a quadruple regimen of tetracycline, metronidazole, bismuth dicitrate, and lansoprazole for 1 week was administered. The rescue regimen for persistently refractory cases was rifaximin 200 mg t.i.d., levofloxacin 500 mg q.d., and lansoprazole 15 mg b.i.d. for 1 week.

Results

In total, 482 patients were enrolled in this study. The eradication rates associated with the first and second regimens were 58% and 60%, respectively. Forty-seven out of 58 patients who failed with the second-line regimen received rifaximin plus levofloxacin-based third-line therapy. The eradication rate for the third regimen was 65%. The cumulative eradication rates were 58%, 85%, and 96% for each regimen, respectively.

Conclusions

A rifaximin plus levofloxacin-based regimen could be an alternative rescue therapy in patients with resistance to both triple and quadruple regimens for the eradication of H. pylori.     

Evolution of care in cirrhosis: Preventing hepatic decompensation through pharmacotherapy

Cirrhosis is a leading cause of morbidity and mortality, impacting more than 120 million people worldwide. Although geographic differences exist, etiologic factors such as alcohol use disorder, chronic viral hepatitis infections, and non-alcoholic fatty liver disease are prevalent in nearly every region. Historically, significant effort has been devoted to modifying these risks to prevent disease progression. Nevertheless, more than 11% of patients with compensated cirrhosis experience hepatic decompensation each year. This transition signifies the most important prognostic factor in the natural history of the disease, corresponding to a decline in median survival to below 2 years. Over the past decade, the need for pharmacotherapies aimed at reducing the risk for hepatic decompensation has been emphasized, and non-selective beta-blockers have emerged as the most effective option to date. However, a critical therapeutic gap still exists, and additional therapies have been proposed, including statins, rifaximin, and sodium-glucose cotransporter-2 inhibitors. Based on the results of innovative retrospective analyses and small-scale prospective trials, these pharmacotherapies represent promising options, but further studies, including randomized controlled trials, are necessary before they can be incorporated into clinical use. This report highlights the potential impact of these agents and others in preventing hepatic decompensation and discusses how this paradigm shift may pave the way for guideline-directed medical therapy in cirrhosis.     

利福昔明胶囊溶出度测定方法的研究

目的　建立利福昔明胶囊溶出度的测定方法。　方法　按中国药典 2 0 0 0年版二部附录XC第二法 ,以0 1mol·L-1盐酸溶液 (含 0 2 %十二烷基硫酸钠 ) 90 0ml为溶剂 ,转速为 75r·min-1,经 45时采样 ,以分光光度法测定 ,检测波长为 410nm。　结果　本法线性范围为 4 72 4～ 82 67μg·ml-1,r =0 9996,平均回收率为 99 3 % ,RSD =0 94% (n=9)。　结论　该方法简便 ,结果准确可靠 ,可作为测定制剂溶出度的方法。