The mechanism of resistance to rifaximin is by chromosomal alteration in the DNA-dependent RNA polymerase which is in contrast to the clinically significant plasmid-mediated resistance that affects other antibiotics. Therefore, the resistance to rifaximin is not transmittable easily between bacteria.10, 14 However, the clinical relevance of this resistance, especially for long-term therapy, needs to be studied. Because the patient under discussion will not come to liver transplantation for at least another year based on her MELD score, the challenge Enzalutamide order is how to

maintain remission from HE until transplantation. The prevention of HE recurrence is important not only to reduce the risk for hospitalization and subsequent infections but also because increasing episodes of HE can adversely affect cognition before and after transplant.2, 15, 16 The patient developed HE despite being adherent on lactulose therapy and portosytemic shunts have been excluded by imaging. Based on these observations, the use of rifaximin as an additive therapy to lactulose is appropriate in this patient to prevent further recurrences. Before we can recommend selleck screening library use of rifaximin as the sole therapy, long-term head-to-head studies are needed demonstrating the superiority of rifaximin over lactulose. It is uncertain whether rifaximin will be useful or safe in her as the liver disease progresses; studies in patients

with MELD scores >19 have been recommended by the FDA.17 The concerns about the long-term use of antibiotic treatment as well as resistance do remain, which is why the FDA label for rifaximin has postmarketing C. difficile surveillance and warning for rifaximin. Ultimately, the most reliable therapy for HE is liver transplantation, and maintaining functionality and health by avoiding subsequent

episodes of HE is a key step toward achieving that goal. Rifaximin is marketed for treatment of HE in 上海皓元 the United States by Salix Pharmaceuticals as Xifaxan 550 (550 mg tablets). It is also available as 200 mg tablets. The cost for a 30-day supply of Xifaxan 550 mg twice daily is $1120, whereas the cost of a 30-day supply of Xifaxan 400 mg three times a day is $900. The cost of a 30-day supply of lactulose (60 mL/day) is $150. “
“The profile and clinical significance of serum hepatitis B surface antigen (HBsAg) levels during long-term nucleoside analogue (NA) therapy in chronic hepatitis B (CHB) is undetermined. From 1994 to 2002, 322 Chinese CHB patients were started on lamivudine in our center. Patients were recruited if they were continuously treated with lamivudine for at least 10 years and maintained favorable virologic responses throughout therapy (HBV DNA <2,000 IU/mL). HBsAg and HBV DNA levels were measured serially, and the predictability of HBsAg kinetics in determining NA-related HBsAg seroclearance was determined. Seventy patients were recruited, of which 43 (61.4%) were hepatitis B e antigen (HBeAg)-positive.