Evaluation of Some of the Antibiotics in the Management of Hepatic Encephalopathy (HE): An Overview

Abstract

Hepatic encephalopathy (HE) is a common complication among patients with liver cirrhosis associated with a high mortality rate. It is marked by fluctuating neuropsychiatric and cognitive impairment, which can be severe and life threatening. Liver cirrhosis is a leading cause of morbidity and mortality worldwide but exact prevalence of cirrhosis is not known. Prevalence of HE, also known as portosystemic encephalopathy (PSE), is 24% in cirrhotic patients. The diagnosis remains largely clinical, with the exclusion of possible other causes for the altered mental status. Symptoms of HE include attention deficits, alterations of sleep patterns and muscular incoordination progressing to stupor and coma. The pathogenesis of HE is still unidentified, although ammonia-induced variations of cerebral neurotransmitter balance, particularly at the astrocyte-neurone edge, may play a major role. Treatment of HE is therefore focused at reducing the manufacture and absorption of gut-derived neurotoxic substances, especially ammonia. Current treatment strategies include antibiotics such as neomycin, rifaximin, metronidazole, vancomycin and probiotics. The present review focuses on the pathogenesis, pathophysiology, diagnosis and management of HE.

Keywords: hepatic encephalopathy (HE), metronidazole, neomycin, probiotics, rifaximin, vancomycin

Cite this Article

Asad Jamal Ansari, Nishat Fatima, Mohammad Monawwar, Mohd Imran, Shweta, Shayna Bano, Alhamd Tanveer. Evaluation of Some of the Antibiotics in the Management of Hepatic Encephalopathy (HE): An Overview. Research & Reviews: A Journal of Pharmacology. 2020; 10(3): 22–39p.