EFFECT OF USING LACTULOSE AND RIFAXIMIN IN COMPARISON WITH LACTULOSE ONLY THERAPY IN TREATEMENT OF HEPATIC ENCEPHALOPATHY: A RANDOMIZED CONTROLLED TRIAL

Objective: To evaluate the effectiveness of using lactulose and rifaximin combination therapy for curing hepatic encephalopathy in adult patients and its comparison with lactulose only treatment. Method: This research was conducted at Jinnah hospital Lahore, department of internal medicine during period of seven months, from December 2014 to June 2015 after taking consent from hospital ethical committee. The study design is randomised controlled trial. Sample size of one hundred and thirty patients was calculated by using WHO calculator. All these cases were stratified into two groups consisting of sixty five patients each. 30ml lactulose 8 hourly was given to one group and the other group was given lactulose and rifaximin 550mg 12 hourly for 10 days. Informed written consent was taken from patients' guardians. West-Haven Classification was used to determine grade two to four hepatic encephalopathy. Patients were followed up for 10 days after admission. Results: The mean age of patients was 56.06±11.2 years amongst which females were 46.9% while males were 53.1%. 58.46% patients showed reversal by taking lactulose only therapy while 67.67% patients who were given lactulose and rifaximin treatment, after ten days of follow up. P value was 0.276, which was not statistically significant. The abovementioned results show that there was no difference in effectiveness of using lactulose and rifaximin combination treatment as compared to lactulose only treatment in patients with grade two to four hepatic encephalopathy. Key words: Rifaximin, Lactulose, Hepatic encephalopathy, Chronic liver disease.