{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T07:04:41Z","timestamp":1792652681143,"version":"4.5.0"},"reference-count":73,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2021,6,7]],"date-time":"2021-06-07T00:00:00Z","timestamp":1623024000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:p>Rifaximin is an oral nonsystemic antibiotic with minimal gastrointestinal absorption and broad\u2010spectrum antibacterial activity covering both gram\u2010positive and gram\u2010negative organisms. Rifaximin is currently used worldwide in patients with cirrhosis for preventing recurrent HE because its efficacy and safety have been proven by large randomized clinical trials. In the last decade, experimental and clinical evidence suggest that rifaximin could have other beneficial effects on the course of cirrhosis by modulating the gut microbiome and affecting the gut\u2010liver axis, which in turn can interfere with major events of the pathophysiological cascade underlying decompensated cirrhosis, such as systemic inflammatory syndrome, portal hypertension, and bacterial infections. However, the use of rifaximin for prevention or treatment of other complications, including spontaneous bacterial peritonitis or other bacterial infections, is not accepted because evidence by clinical trials is still very weak. The present review deals in the first part with the potential impact of rifaximin on pathogenic mechanisms in liver diseases, whereas in the second part, its clinical effects are critically discussed. It clearly emerges that, because of its potential activity on multiple pathogenic events, the efficacy of rifaximin in the prevention or management of complications other than HE deserves to be investigated extensively. The results of double\u2010blinded, adequately powered randomized clinical trials assessing the effect of rifaximin, alone or in combination with other drugs, on hard clinical endpoints, such as decompensation of cirrhosis, acute\u2010on\u2010chronic liver failure, and mortality, are therefore eagerly awaited.<\/jats:p>","DOI":"10.1002\/hep.31708","type":"journal-article","created":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T19:13:36Z","timestamp":1610651616000},"page":"1660-1673","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":134,"title":["The Use of Rifaximin in Patients With Cirrhosis"],"prefix":"10.1097","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1439-056X","authenticated-orcid":false,"given":"Paolo","family":"Caraceni","sequence":"first","affiliation":[{"name":"University of Bologna,University Hospital S. Orsola\u2010Malpighi di Bologna,Bologna,Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Vargas","sequence":"additional","affiliation":[{"name":"Hospital Vall d\u2019Hebron,Universitat Aut\u00f2noma de Barcelona,CIEREHD,Barcelona,Catalonia,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elsa","family":"Sol\u00e0","sequence":"additional","affiliation":[{"name":"Hospital Clinic of Barcelona,University of Barcelona,IDIBAPS,CIBEReHD,Barcelona,Catalonia,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Alessandria","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Citt\u00e0 della Salute e della Scienza Hospital,University of Torino,Turin,Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8472-8549","authenticated-orcid":false,"given":"Koos","family":"de Wit","sequence":"additional","affiliation":[{"name":"Amsterdam University Medical Centers,Amsterdam,the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7028-3881","authenticated-orcid":false,"given":"Jonel","family":"Trebicka","sequence":"additional","affiliation":[{"name":"Goethe\u2010University \u2010 Frankfurt am Main,Frankfurt am Main,Germany"},{"name":"EF\u2010CLIF,Barcelona,Catalonia,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Angeli","sequence":"additional","affiliation":[{"name":"University Hospital of Padova,Padova,Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajeshwar P.","family":"Mookerjee","sequence":"additional","affiliation":[{"name":"Royal Free Hospital,University College London,London,United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Durand","sequence":"additional","affiliation":[{"name":"Hospital Beaujon,APHP,Paris,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Pose","sequence":"additional","affiliation":[{"name":"Hospital Clinic of Barcelona,University of Barcelona,IDIBAPS,CIBEReHD,Barcelona,Catalonia,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksander","family":"Krag","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Odense University Hospital,Odense,Denmark"},{"name":"Institute of Clinical Research,University of Southern Denmark,Odense,Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4928-3681","authenticated-orcid":false,"given":"Jasmohan S.","family":"Bajaj","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University Medical Center,Richmond,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Beuers","sequence":"additional","affiliation":[{"name":"Amsterdam University Medical Centers,Amsterdam,the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4657-4504","authenticated-orcid":false,"given":"Pere","family":"Gin\u00e8s","sequence":"additional","affiliation":[{"name":"Hospital Clinic of Barcelona,University of Barcelona,IDIBAPS,CIBEReHD,Barcelona,Catalonia,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Liverhope Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,6,7]]},"reference":[{"key":"hep31708-bib-0001-20250824","first-page":"399","article-title":"Treatment of hepatic encephalopathy by alteration of intestinal flora with lactobacillus acidophilus","volume":"1","year":"1965","journal-title":"Lancet"},{"key":"hep31708-bib-0002-20250824","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1056\/NEJM199708143370707","article-title":"Treatment of hepatic encephalopathy","volume":"337","year":"1997","journal-title":"N Engl J Med"},{"key":"hep31708-bib-0003-20250824","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/S0016-5085(77)80135-2","article-title":"Comparison of lactulose and neomycin in the treatment of chronic portal\u2010systemic encephalopathy. 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