Can rifaximin for hepatic encephalopathy be discontinued during broad-spectrum antibiotic treatment?

Core Tip

Core Tip: Rifaximin (RFX) is a gut-restricted adjunct to lactulose that minimizes hepatic encephalopathy (HE) recurrence with minimal systemic absorption. Despite established benefits, limited Food and Drug Administration approval for acute HE raises concern about its use in treating acute overt HE. Recent evidence challenges the routine use of RFX with broad-spectrum antibiotics, emphasizing their class-specific effects in critically ill patients. The study sheds light on the safety of discontinuing RFX during broad-spectrum antibiotic therapy in intensive care unit patients with liver disease and HE, and also prompts reevaluation of the role of RFX amid the overlapping antibiotic activity. This evidence underscores the need for further investigations to optimize the management of both HE and systemic infections in patients with liver disease, including those who are not critically ill.