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Antibiotics With or Without Rifaximin for Acute Hepatic Encephalopathy in Critically Ill Patients With Cirrhosis: A Double-Blind, Randomized Controlled (ARiE) Trial by Anand V. Kulkarni; Mahathi Avadhanam; Puja Karandikar; Kalyan Rakam; Anand Gupta; Venu Simhadri; Madhumita Premkumar; Asim Ahmed Zuberi; Deepika Gujjarlapudi; Ramyashri Narendran; Sameer Shaik; Mithun Sharma; Sowmya Iyengar; Manasa Alla; Shantan Venishetty; Duvvur Nageshwar Reddy; Padaki Nagaraja Rao is a Medicine article available to read on EtoBox.

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## INTRODUCTION: Critically ill patients with cirrhosis admitted to the intensive care unit (ICU) are usually on broad-spectrum antibiotics because of suspected infection or as a hospital protocol. It is unclear if additional rifaximin has any synergistic effect with broad-spectrum antibiotics in ICU patients with acute overt hepatic encephalopathy (HE). ## METHODS: In this double-blind trial, patients with overt HE admitted to ICU were randomized to receive antibiotics (ab) alone or antibiotics with rifaximin (ab + r). Resolution (or 2 grade reduction) of HE, time to resolution of HE, in-hospital mortality, nosocomial infection, and changes in endotoxin levels were compared between the 2 groups. A subgroup analysis of patients with decompensated cirrhosis and acute-on-chronic liver failure was performed. ## RESULTS: Baseline characteristics and severity scores were similar among both groups (92 in each group). Carbapenems and cephalosporin with beta-lactamase inhibitors were the most commonly used ab. On Kaplan-Meier analysis, 44.6% (41/92; 95% confidence interval [CI], 32–70.5) in ab-only arm and 46.7% (43/92; 95% CI, 33.8–63) in ab + r arm achieved the primary objective (__P__ =

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Author

Anand V. Kulkarni; Mahathi Avadhanam; Puja Karandikar; Kalyan Rakam; Anand Gupta; Venu Simhadri; Madhumita Premkumar; Asim Ahmed Zuberi; Deepika Gujjarlapudi; Ramyashri Narendran; Sameer Shaik; Mithun Sharma; Sowmya Iyengar; Manasa Alla; Shantan Venishetty; Duvvur Nageshwar Reddy; Padaki Nagaraja Rao

Publisher

Ovid Technologies (Wolters Kluwer Health)

Published

2024

Language

EN

Field

Medicine (Health Sciences)