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Open Access Research article

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

Fernando Gomes Romeiro15*, Fabio da Silva Yamashiro1, Madileine Francely Américo2, Luciana Aparecida Corá3, Giovanni Faria Silva1, JoséRicardodeArruda Miranda4 and Carlos Antonio Caramori1

Author affiliations

1 Department of Internal Medicine, Faculdade de Medicina de Botucatu, UNESP – Universidade Estadual Paulista, Botucatu, Brazil

2 Biological and Health Sciences Institute, Campus Médio Araguaia, UFMT –Universidade Federal do Mato Grosso, Barra do Garças, Brazil

3 Health Sciences Center, UNCISAL – Universidade Estadual de Ciências da Saúde de Alagoas, Maceió, Brazil

4 Department of Physics and Biophysics, Instituto de Biociências de Botucatu, UNESP – Universidade Estadual Paulista, Botucatu, Brazil

5 Department of Internal Medicine – Botucatu Medical School, UNESP– Universidade Estadual Paulista, Distrito de Rubião Jr. s/n zip code 18 608 917, Botucatu, São Paulo, Brazil

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Citation and License

BMC Gastroenterology 2013, 13:13  doi:10.1186/1471-230X-13-13

Published: 16 January 2013

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords:
Hepatic encephalopathy; Liver cirrhosis; Erythromycin; Neomycin