Erythromycin versus neomycin in the treatment of hepatic encephalopathy in cirrhosis: a randomized double-blind study

• Published in: BMC gastroenterology Vol. 13; no. 1; p. 13
• Main Authors: Romeiro, Fernando Gomes, da Silva Yamashiro, Fabio, Américo, Madileine Francely, Corá, Luciana Aparecida, Silva, Giovanni Faria, Miranda, José Ricardo de Arruda, Caramori, Carlos Antonio
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16-01-2013; BioMed Central; BMC
• Subjects: Administration, Oral; Adult; Aged; Alanine Transaminase - metabolism; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Bacterial infections; C-Reactive Protein - metabolism; Comparative analysis; Dose-Response Relationship, Drug; Double-Blind Method; Drug therapy; Erythromycin; Erythromycin - administration & dosage; Erythromycin - therapeutic use; Female; Gastroenterology; Hepatic encephalopathy; Hepatic Encephalopathy - drug therapy; Hepatic Encephalopathy - etiology; Hepatic Encephalopathy - metabolism; Hospitalization; Humans; Infections; Length of Stay; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - metabolism; Male; Middle Aged; Neomycin; Neomycin - administration & dosage; Neomycin - therapeutic use; Patient outcomes; Studies; Treatment Outcome
• ISSN: 1471-230X; 1471-230X
• DOI: 10.1186/1471-230X-13-13

Hepatic encephalopathy (HE) is a severe complication in patients with hepatic cirrhosis, which causes numerous hospital admissions and deaths. Antibiotics are the best options in HE treatment, but head-to-head comparisons between these drugs are scarce. Erythromycin combines the antimicrobial effect and prokinetic properties in the same drug, but it has never been used in HE treatment. Our aim was to evaluate the efficacy of erythromycin as an HE treatment.
We achieved a randomized controlled trial of adult patients with HE and hepatic cirrhosis admitted in our hospital. After randomization, the subjects received either erythromycin 250 mg or neomycin 1 g orally QID until hospital discharge or prescription of another antibiotic. All subjects were blindly evaluated every day towards quantifying clinical, neuropsychometric, hepatic and renal exams. Statistical analysis was employed to compare the groups and correlate the variables with hospitalization duration.
30 patients were evaluated (15 treated with each drug). At hospital admission, the groups were homogeneous, but the erythromycin group subjects achieved a shorter hospitalization stay (p = 0.032) and a more expressive reduction in alanine aminotranspherase levels (p = 0.026). Hospitalization duration was positively correlated with C reactive protein levels measured previous to (p = 0.015) and after treatment (p = 0.01).
In the sample evaluated erythromycin was associated with significant reductions in hospital stay and in alanine aminotranspherase values. Hospitalization time was positive correlated with C reactive protein levels measured before and after the treatments.