Comparison of the Efficacy of Rifaximin Versus Metronidazole in Patients With Hepatic Encephalopathy at a Tertiary Care Hospital

Muhammad Shafiq  Akbar; Javed  Iqbal; Muhammad Moeen  Khan; Nabiha  Afzal; . Mahnoor; Hafiz Naeem  Ali

doi:10.54112/bcsrj.v6i6.2149

Authors

Muhammad Shafiq Akbar Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan
Javed Iqbal Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan
Muhammad Moeen Khan Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan
Nabiha Afzal Tehsil Headquarter Hospital, AliPur, Pakistan
. Mahnoor Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan
Hafiz Naeem Ali Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i6.2149

Keywords:

Pregabalin, Hemodynamics, Pneumoperitoneum

Abstract

Hepatic encephalopathy (HE) is a serious neurocognitive complication of liver cirrhosis, contributing substantially to morbidity, hospitalizations, and mortality. Antibiotics such as rifaximin and metronidazole are widely used to reduce gut-derived ammonia; however, evidence regarding their comparative efficacy in acute HE remains inconsistent, particularly in South Asian populations. This study evaluated and compared the effectiveness of rifaximin and metronidazole in patients with hepatic encephalopathy admitted to a tertiary care hospital in Pakistan. Objective: To compare the efficacy of rifaximin versus metronidazole in patients with hepatic encephalopathy using the West Haven criteria. Methods: A randomized controlled trial was conducted in the Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan. Ninety patients aged 20–70 years presenting within 48 hours of the onset of hepatic encephalopathy were enrolled and randomly allocated into two groups: Group A received intravenous metronidazole 500 mg every eight hours, while Group B received rifaximin 550 mg twice daily. Both treatments were administered for seven days. Efficacy was defined as an improvement of at least one grade on the West Haven scale. Demographic variables, comorbidities, and baseline HE grades were recorded. Data were analyzed using SPSS version 25, with the Chi-square test used to compare efficacy between groups. Results: The cohort's mean age was 54.2 ± 9.8 years, with males accounting for 67.8%. Baseline characteristics, including comorbidities and HE grades, were comparable between groups. After 7 days of treatment, efficacy was significantly higher in the metronidazole group, with 75.6% of patients demonstrating improvement, compared with 42.2% in the rifaximin group (p = 0.002). Stratified analysis showed consistent superiority of metronidazole across gender, diabetes, hypertension, and HE Grades II and III. No significant adverse effects were reported in either treatment group. Conclusion: Metronidazole was significantly more effective than rifaximin in improving hepatic encephalopathy over a seven-day treatment period. These findings support the preferential use of metronidazole for acute HE management in resource-limited settings such as Pakistan, where cost-effective and rapidly acting treatment options are essential.

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