title: Erythromycin versus neomycin in the treatment of hepatic encephalopathy in cirrhosis: a randomized double-blind study.
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.
authors: Department of Internal Medicine, Faculdade de Medicina de Botucatu, UNESP - Universidade Estadual Paulista, Botucatu, Brazil. fgromeiro@gmail.com
authors: Fernando Gomes
authors: FG
authors: Romeiro
authors: Fabio
authors: F
authors: da Silva Yamashiro
authors: Madileine Francely
authors: MF
authors: Américo
authors: Luciana Aparecida
authors: LA
authors: Corá
authors: Giovanni Faria
authors: GF
authors: Silva
authors: José Ricardo de Arruda
authors: JR
authors: Miranda
authors: Carlos Antonio
authors: CA
authors: Caramori
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004917:Erythromycin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006501:Hepatic Encephalopathy / Q000188:drug therapy* / Q000209:etiology* / Q000378:metabolism; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009355:Neomycin / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004917:Erythromycin; D002097:C-Reactive Protein; D000410:Alanine Transaminase; D009355:Neomycin