[Correspondence] Therapeutic drift or formulation drift: avoiding misconceptions about rifaximin and antimicrobial resistance in cirrhosis – Authors' reply

Abstract

We thank Carmelo Scarpignato and Manuel Romero-Gómez for their thoughtful Correspondence, and we agree on most of the key points made. Rifaximin remains a valuable drug, its place in the secondary prevention of recurrent overt hepatic encephalopathy is secure, and antimicrobial resistance in advanced cirrhosis is multifactorial. Our argument centres on the framework that an antimicrobial therapy often taken for years by patients with the profound immune dysfunction of advanced cirrhosis warrants the same prescribing rigour and clinical oversight as any other antibiotic therapy.