COMPARISON OF 550MG/DAY VERSES 1100 MG/DAY RIFAXIMIN IN SECONDARY PREVENTION OF BOTH COVERT AND OVERT HEPATIC ENCEPHALOPATHY

Hepatic encephalopathy (HE) is a serious complication of liver cirrhosis, presenting in covert and overt forms, and often recurs after initial treatment. Rifaximin, a non-absorbable antibiotic, is widely used for secondary prevention, but the optimal dose for preventing HE recurrence remains uncertain. Objective: To compare the frequency of recurrence of both covert and overt hepatic encephalopathy in patient taking rifaximin at 550mg/day verses 1100mg/day. Study Design: Randomized, controlled, comparative study. Setting: Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan. Duration of Study: Six months, from September 6, 2024, to March 6, 2025. Methods: A total of 160 patients diagnosed with either covert or overt HE were enrolled and randomized into two treatment groups via block randomization. Group A received 550 mg/day rifaximin, and Group B received 1100 mg/day. The primary outcome was the frequency of HE recurrence over the study period. Statistical analysis was performed using SPSS version 26. Chi-square test was applied to compare recurrence rates between groups, with p < 0.05 considered statistically significant. Results: In Group A, 47.5% of patients experienced recurrence of HE, compared to 43.8% in Group B. The difference in recurrence rates between the two groups was not statistically significant (p = 0.63). Conclusion: There was no significant difference in the efficacy of 550 mg/day versus 1100 mg/day rifaximin in preventing HE recurrence. Given the comparable outcomes, the standard 550 mg/day dose remains the preferred regimen for secondary prevention of hepatic encephalopathy due to its effectiveness and potential cost-benefit advantage.