Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2023; 15(11): 1226-1236
Published online Nov 27, 2023. doi: 10.4254/wjh.v15.i11.1226
Evaluation of a protocol for rifaximin discontinuation in critically ill patients with liver disease receiving broad-spectrum antibiotic therapy
Jessica A Ward, Jason Yerke, Mollie Lumpkin, Aanchal Kapoor, Christina C Lindenmeyer, Stephanie Bass
Jessica A Ward, Jason Yerke, Mollie Lumpkin, Stephanie Bass, Department of Pharmacy, Cleveland Clinic, Cleveland, OH 44195, United States
Aanchal Kapoor, Department of Critical Care Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
Christina C Lindenmeyer, Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH 44195, United States
Author contributions: Ward JA provided study design, data collection, data analysis and interpretation, and manuscript preparation; Bass S was the guarantor of the study and contributed to study design, data interpretation, and manuscript preparation; Yerke J, Lumpkin M, Kapoor A, and Lindenmeyer CC contributed to study design, data interpretation, and manuscript preparation.
Institutional review board statement: The study was reviewed and approved by the Cleveland Clinic Institutional Review Board (Cleveland).
Informed consent statement: The requirement for informed consent for this study was waived due to the minimal risk posed to included patients.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jessica A Ward, PharmD, Pharmacist, Department of Pharmacy, Cleveland Clinic, No. 9500 Euclid Avenue, Hb-115, Cleveland, OH 44195, United States. wardj4@ccf.org
Received: July 8, 2023
Peer-review started: July 8, 2023
First decision: August 15, 2023
Revised: September 5, 2023
Accepted: October 23, 2023
Article in press: October 23, 2023
Published online: November 27, 2023
Processing time: 138 Days and 13.3 Hours
Core Tip

Core Tip: Critically ill patients with liver disease receiving broad-spectrum antibiotic therapy have been frequently excluded from clinical trials of rifaximin efficacy. Therefore, despite overlapping spectrums of antibacterial activity, it is not known if rifaximin provides additional clinical benefit in these patients. In this study, pharmacist-guided rifaximin discontinuation during broad-spectrum antibiotic therapy resulted in significant cost savings and was not associated with negative short-term cognitive effects or adverse events.