Comparison of current and emerging strategies for treating hepatic encephalopathy.

Objective: To compare the efficacy of rifaximin and metronidazole which are the most commonly used antibiotics used in treating this disorder. Study Design: Randomized Controlled Trial. Setting: Department of Medicine, Sharif Trust Hospital. Period: Jan 2018 to July 2018. Material & Methods: In this study cirrhotic patients irrespective of etiology were enrolled. West Haven Criteria (WHC) was utilized for grading the symptoms of HE at baseline and after 7 days of treatment. The study subjects were further subdivided into two groups: rifa group and metro group, and were given rifaximin and metronidazole respectively along with lactulose. The efficacy of the treatment and adverse effects in both the groups were estimated. Results: Total 180 subjects with HE (grade- III or IV) were selected, 90 subjects were subdivided into each group. Out of 90 subjects of Rifa group, efficacy of treatment was noted in 14 (15%) patients and out of 90 subjects of Metro Group, treatment was found effective in 45 (50%) patients with p value of 0.0001. Conclusion: The conclusion of this study is that metronidazole is superior to rifaximin in terms of efficacy in the management of an acute phase of hepatic encephalopathy due to chronic liver cirrhosis. Hence, due to its cheaper cost and a good safety margin its use is recommend in poor resource settings.