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. 2021 May 15;60(10):1501-1507.
doi: 10.2169/internalmedicine.6039-20. Epub 2020 Dec 22.

Efficacy of Switching from Kanamycin Sulfate to Rifaximin in Patients with Hepatic Cirrhosis

Ryoji Tatsumi  1 , Hirokazu Suii  1 , Masakatsu Yamaguchi  1 , Tomohiro Arakawa  1 , Tomoaki Nakajima  1 , Yasuaki Kuwata  1 , Joji Toyota  1 , Shuhei Hige  1
Affiliations

Efficacy of Switching from Kanamycin Sulfate to Rifaximin in Patients with Hepatic Cirrhosis

Ryoji Tatsumi et al. Intern Med. .

Abstract

Objective This study evaluated the efficacy associated with switching to rifaximin in patients with hepatic cirrhosis receiving kanamycin sulfate for the treatment of hepatic encephalopathy and hyperammonemia. Methods We included 37 patients who switched from kanamycin sulfate to rifaximin at our institution from January 2017 to December 2018. The onset of hepatic encephalopathy and changes in blood ammonia values during a six-month period were retrospectively evaluated. Results There were 4 (11%) patients with hepatic encephalopathy at the time of switching from kanamycin sulfate to rifaximin. The cumulative incidence of hepatic encephalopathy was 3% and 16% at 3 and 6 months later, respectively. The blood ammonia levels at the time of switching to rifaximin and at 3 and 6 months later were 94 (range, 20-243) μg/dL, 95 (range, 33-176) μg/dL, and 81 (range, 32-209) μg/dL, respectively, and no significant changes were observed. However, in the 11 patients receiving an oral dose of <1,500 mg/day of kanamycin sulfate, the blood ammonia levels at the time of switching and at 3 and 6 months later were 136 (range, 35-243) μg/dL, 95 (range, 33-150) μg/dL, and 63 (range, 43-124) μg/dL, respectively. Furthermore, the blood ammonia levels significantly decreased at the time of the switching to rifaximin and at three and six months later (p=0.043 and p=0.011, respectively). Conclusion Switching to rifaximin in hepatic cirrhosis patients receiving kanamycin sulfate to treat hepatic encephalopathy and hyperammonemia showed effects that were equivalent to or greater than the original therapy, thereby demonstrating the clinical efficacy.

Keywords: cirrhosis; hepatic encephalopathy; kanamycin sulfate; rifaximin.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
The cumulative incidence of hepatic encephalopathy after switching from kanamycin sulfate to rifaximin was 3% and 16% after three and six months, respectively.
Figure 2.
Figure 2.
The onset of hepatic encephalopathy six months before and after switching to rifaximin. Circles indicate that patients developed hepatic encephalopathy at least once a month.
Figure 3.
Figure 3.
Changes in blood ammonia levels after switching from kanamycin sulfate to rifaximin. (a) All patients who switched from kanamycin sulfate to rifaximin. (b) Patients who switched from kanamycin sulfate to rifaximin who were receiving an oral dose of <1,500 mg/day of kanamycin sulfate. (c) Patients who switched from kanamycin sulfate to rifaximin who were receiving an oral dose of ≥1,500 mg/day of kanamycin sulfate.
Figure 4.
Figure 4.
Patients with Child-Pugh class A, B, and C after switching to rifaximin. On comparing the status at the time of switching to rifaximin with that at six months later, the Child-Pugh class had improved in 3 patients (8%) but worsened in 7 patients (19%).
Figure 5.
Figure 5.
Concomitant oral medication after switching to rifaximin.
See this image and copyright information in PMC

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