Comparing Nifuroxazide Plus Lactulose With Lactulose Alone in the Treatment of Hepatic Encephalopathy
Study Details
Study Description
Brief Summary
Evaluating the efficacy and safety of the efficacy and safety of nifuroxazide in combination with lactulose in comparison to lactulose alone in the treatment of hepatic encephalopathy in patients with grade II-III hepatic encephalopathy
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
Phase 3 |
Detailed Description
Hepatic Encephalopathy (HE) is a central nervous system dysfunction caused by liver insufficiency and/or portosystemic shunting, manifesting as a wide spectrum of neurological or psychiatric abnormalities characterized by alteration of cognitive and motor function.
The pathogenesis of hepatic encephalopathy is believed to be due to increased nitrogenous substances, primarily ammonia, in the blood. The treatment goal is to reduce nitrogen load from the GI tract and to improve central nervous system (CNS) status.
Treatment options include lactulose administered orally and non-absorbable antibiotics.
Lactulose is nonabsorbable disaccharides that is currently used as first line agents for the treatment of HE. Its action is thought to be due to Colonic metabolism of lactulose to lactic acid results in acidification of the gut lumen. This favors conversion of ammonium (NH4) to ammonia (NH3) and the passage of ammonia from tissues into the lumen. Gut acidification inhibits ammoniagenic coliform bacteria, leading to increased levels of nonammoniagenic lactobacilli. Lactulose also works as a cathartic, reducing colonic bacterial load.
Nifuroxazide is an oral broad-spectrum nitrofuran antibiotic that is commonly used as an intestinal anti-infective agent. It is active against the majority of intestinal bacteria:
Gram-positive (Staphylococcus family) and Gram-negative (Enterobacteriaceae family:
Escherichia, Citrobacter, Enterobacter, Klebsiella, Salmonella, Shigella, Yersinia) and is therefore expected to decrease ammonia production and to reverse the symptoms of HE.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Experimental: lactulose plus nifuroxazide Nifuroxazide dosing : 800 mg daily in 4 divided doses for 7 days Lactulose dosing : 30 to 60 mL PO TID to produce 2 to 3 semisoft stools per day. |
Drug: Nifuroxazide
Nifuroxazide dosing : 200 mg capsule four times daily
Drug: Lactulose
Lactulose dosing: 30-60 mL PO TID with goal 2-3 semisoft stools
|
Active Comparator: Lactulose alone Lactulose dosing : 30 to 60 mL PO TID to produce 2 to 3 semisoft stools per day. |
Drug: Lactulose
Lactulose dosing: 30-60 mL PO TID with goal 2-3 semisoft stools
|
Outcome Measures
Primary Outcome Measures
- Number of patients achieving complete reversal of hepatic encephalopathy [7 days]
Complete reversal is defined as the reversibility of HE from grade 2 or 3 to grade 0 or 1 according to West Haven criteria
- The time for complete reversal of HE [7 days]
- Evaluating the efficacy of nifuroxazide in improving mental status by calculating CHESS score [7 days]
Evaluating the efficacy by measuring serum ammonia at baseline and at end of treatment and calculating (CHESS) score at baseline and at end of treatment.
Secondary Outcome Measures
- Length of hospital stay [7 days]
- the rate of adverse events occurring during the treatment [Maximum 7 days]
Number of patients who experienced adverse events such as abdominal pain, vomiting, nausea, flatulence, anorexia, rash and headache.
Eligibility Criteria
Criteria
Inclusion Criteria:
- Patients suffering from liver cirrhosis aging from 18-64 years who will be admitted to hospital with neuropsychiatric condition suggestive of hepatic encephalopathy (grade II or III) confirmed by their known previous hepatic disease by history, clinical examination and laboratory investigations in the form of hyperammonemia with Model for End-Stage Liver Disease (MELD) score ≤ 25 and patients are able to swallow.
Exclusion Criteria:
-
Patients with neurological or communication problems.
-
Degenerative central nervous system (CNS) disease.
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Any significant psychiatric illness.
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Patients with previous intake of nifuroxazide and rifaximin within the last month.
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Anemia with hemoglobin level < 8 g/dL.
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Presence of underlying renal impairment (serum creatinine > 1.5 mg/dL).
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Alcohol consumption within prior 4 weeks.
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Non-hepatic metabolic encephalopathy.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | National Hepatology and Tropical Medicine Research Institute (NHTMRI) | Cairo | Egypt |
Sponsors and Collaborators
- Cairo University
Investigators
- Principal Investigator: Mennat Allah S. Emam, Cairo University
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- CL (3202)