Comparison of Safety and Efficacy of Neomycin versus Rifaximin in Chronic Recurrent Hepatic Encephalopathy

Abstract Background Hepatic encephalopathy (HE) is a potentially reversible neuropsychiatric and functional syndrome occurring in 50%-70% of patients with advanced liver disease, the most recent guidelines from the American Association for the Study of Liver Disease (AASLD) and European Association for the Study of the Liver (EASL) suggest a universal definition of HE: “a brain dysfunction caused by liver insufficiency and/or portosystemic shunting. It manifests as a wide spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations to coma. Aim of the Work To compare between the efficacy and safety of neomycin versus rifaximin in management of recurrent hepatic encephalopathy. Patients and Methods This retrospective study was conducted on 240 patients diagnosed with liver cirrhosis and experienced recurrent hepatic encephalopathy and collected from Internal Medicine and Gastroenterology Clinics, at Ain Shams university hospitals in a period of 6 months starting from April 2023 till October 2023. Results They were 123 females (51.25%) and 117 males (48.75%) with age ranged from 40 – 75 years and with mean±SD of 56.51 ± 9.10. hemoglobin level was significantly decreased post treatment in Rifaximin group [−8.75 (−15.65 – 1.11)] than neomycin [−1.96 (−3.57 – 0.89)] and mixed [0.11 (−4.55 – 4.91)] groups with p-value <0.001. Also, the level of WBCs was significantly increased in Rifaximin [12.73 (2.53 – 75)] and Mixed [15.56 (9.09 – 24.53)] groups than Neomycin group [6.45(−10.09 – 15.56)] with p−value <0.001 while the level of platelets was significantly increased in Rifaximin [10.93(−23.89 – 47.69)] and decreased in Neomycin [−5.41 (−9.02 – −2.94)] and Mixed [−5.36 (−10.00 – 3.8)] groups with significant difference between Rifaximin and the other two groups with p−value = 0.016. Conclusion Over a 6-month period, treatment with neomycin maintained remission from hepatic encephalopathy more effectively than did Rifaximin and mixed use of both neomycin and rifaximin. Also significantly reduced the risk of hospitalization involving hepatic encephalopathy, less hospital stay, better survival and quality of life, Neomycin in managing chronic recurrent hepatic encephalopathy was associated with lower serum creatinine levels and fewer nephrotoxic side effects in comparison to rifaximin and mixed use of neomycin and rifaximin together.