Rifaximin Linked to Reduced Infection Rate in Alcohol-Associated Hepatitis

The antibiotic rifaximin is associated with reducing infection rate in patients with alcohol-related hepatitis.

Patients with alcohol-associated hepatitis (AAH) who received rifaximin had a significantly lower rate of infections compared with those who did not receive rifaximin, according to a study in the Journal of Gastroenterology and Hepatology.

Researchers conducted a systematic review and meta-analysis to assess evidence of the role of rifaximin in the management of AAH.1 They performed a literature search in MEDLINE, the Cochrane Central Register of Controlled Trials, the Web of Science Core Collection, and Google Scholar on August 19, 2022, with a final updated search on February 7, 2023.

Eligible studies included patients with AAH and original data that compared clinical outcomes and/or adverse events in patients receiving standard of care treatment with those who also received rifaximin. The outcomes of interest included infection rates, 90-day mortality, and overall mortality between the 2 groups of patients.

The final meta-analysis included 3 studies (2 randomized controlled trials and 1 case-control study), with 162 patients (69% male).

Further studies … are needed to establish the role of rifaximin in AAH, especially as an adjunct therapy with prednisolone.

The rifaximin group had a significantly lower rate of bacterial infection compared with the nonrifaximin group (risk ratio [RR], 0.331; CI, 0.159-0.689; I2=0%; P =.003). In 1 study,2 4 of 21 patients in the rifaximin group had 6 infections, and 18 of 42 patients in the nonrifaximin group had 26 infections, 8 of which progressed to sepsis.

No significant difference in 90-day mortality rate was observed in the rifaximin group vs the nonrifaximin group (RR, 0.743; CI, 0.298-1.850; I2=24%; P =.523). In addition, no significant difference in overall mortality rate was found in the rifaximin group vs the nonrifaximin group (RR, 0.723; CI, 0.406-1.189; I2=0%; P =.272).

Among several limitations, the included studies used slightly different inclusion criteria to define AAH as well as different treatment regimens as the standard therapy in the control group. Also, the sample size was small, and subgroup analyses based on concurrent prednisolone use were not performed owing to the lack of specific available data. In addition, the analysis is susceptible to selection bias.

“Further studies, particularly large randomized controlled trials, are needed to establish the role of rifaximin in AAH, especially as an adjunct therapy with prednisolone,” the study authors wrote.

This article originally appeared on Gastroenterology Advisor


  1. Ahmed Z, Badal J, Nawras M, et al. Role of rifaximin in the management of alcohol-associated hepatitis: a systematic review and meta-analysis. J Gastroenterol Hepatol. Published online March 14, 2023. doi:10.1111/jgh.16179
  2. Jiménez C, Ventura-Cots M, Sala M, et al. Effect of rifaximin on infections, acute-on-chronic liver failure and mortality in alcoholic hepatitis: a pilot study (RIFA-AH). Liver Int. 2022;42(5):1109-1120. doi:10.1111/liv.15207