Erythromycin versus neomycin in the treatment of hepatic encephalopathy in cirrhosis: A randomized double-blind study
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Springer Nature
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Background: Hepatic encephalopathy (HE) is a severe complication in patients with hepatic cirrhosis, which causes numerous hospital admissions and deaths. Antibiotics are the best options in HE treatment, but head-to-head comparisons between these drugs are scarce. Erythromycin combines the antimicrobial effect and prokinetic properties in the same drug, but it has never been used in HE treatment. Our aim was to evaluate the efficacy of erythromycin as an HE treatment.Methods: We achieved a randomized controlled trial of adult patients with HE and hepatic cirrhosis admitted in our hospital. After randomization, the subjects received either erythromycin 250 mg or neomycin 1 g orally QID until hospital discharge or prescription of another antibiotic. All subjects were blindly evaluated every day towards quantifying clinical, neuropsychometric, hepatic and renal exams. Statistical analysis was employed to compare the groups and correlate the variables with hospitalization duration.Results: 30 patients were evaluated (15 treated with each drug). At hospital admission, the groups were homogeneous, but the erythromycin group subjects achieved a shorter hospitalization stay (p = 0.032) and a more expressive reduction in alanine aminotranspherase levels (p = 0.026). Hospitalization duration was positively correlated with C reactive protein levels measured previous to (p = 0.015) and after treatment (p = 0.01).Conclusions: In the sample evaluated erythromycin was associated with significant reductions in hospital stay and in alanine aminotranspherase values. Hospitalization time was positive correlated with C reactive protein levels measured before and after the treatments. © 2013 Romeiro et al.; licensee BioMed Central Ltd.
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Erythromycin Hepatic encephalopathy Liver cirrhosis Neomycin alanine aminotransferase antibiotic agent C reactive protein erythromycin erythromycin estolate neomycin adult alanine aminotransferase blood level antibiotic therapy clinical article clinical evaluation clinical examination controlled study double blind procedure drug efficacy female hepatic encephalopathy hospital admission hospital discharge hospitalization human kidney examination length of stay liver cirrhosis liver examination male neuropsychological test prescription protein blood level quantitative analysis randomization randomized controlled trial treatment response Administration, Oral Adult Aged Alanine Transaminase Anti-Bacterial Agents C-Reactive Protein Dose-Response Relationship, Drug Double-Blind Method Female Hepatic Encephalopathy Humans Length of Stay Liver Cirrhosis Male Middle Aged Treatment Outcome
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Inglês
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BMC Gastroenterology, v. 13, n. 1, 2013.
