Editor—In their clinical review on portal hypertension Krige and Beckingham mention neomycin as treatment for hepatic encephalopathy.1 Although neomycin has been used as a standard treatment of hepatic encephalopathy for almost 40 years, there is no evidence that the drug is effective. The only randomised, placebo controlled study found no benefit of neomycin compared with standard treatment alone.2 Also, the combination of neomycin with lactulose was not superior to placebo.3 On the basis of these negative studies and the potential for serious adverse effects of this drug, neomycin should not be prescribed for hepatic encephalopathy. Other antibiotics, including paromomycin, metronidazole, vancomycin, and rifaximin, are better tolerated, and several randomised controlled trials support their efficacy.4,5
References
- 1.Krige JE, Beckingham IJ. ABC of diseases of liver, pancreas, and biliary system: portal hypertension-2. Ascites, encephalopathy, and other conditions. BMJ. 2001;322:416–418. doi: 10.1136/bmj.322.7283.416. . (24 February.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Strauss E, Tramote R, Silva EP, Caly WR, Honain NZ, Maffei RA, et al. Double-blind randomized clinical trial comparing neomycin and placebo in the treatment of exogenous hepatic encephalopathy. Hepatogastroenterology. 1992;39:542–545. [PubMed] [Google Scholar]
- 3.Blanc P, Daures JP, Liautard J, Buttigieg R, Desprez D, Pageaux G, et al. Lactulose-neomycin combination versus placebo in the treatment of acute hepatic encephalopathy. Results of a randomized controlled trial. Gastroenterol Clin Biol. 1994;18:1063–1068. [PubMed] [Google Scholar]
- 4.Williams R, James OF, Warnes TW, Morgan MY. Evaluation of the efficacy and safety of rifaximin in the treatment of hepatic encephalopathy: a double-blind, randomized, dose-finding multi-centre study. Eur J Gastroenterol Hepatol. 2000;12:203–208. doi: 10.1097/00042737-200012020-00012. [DOI] [PubMed] [Google Scholar]
- 5.Miglio F, Valpiani D, Rossellini SR, Ferrieri A. Rifaximin, a non-absorbable rifamycin, for the treatment of hepatic encephalopathy. A double-blind, randomised trial. Curr Med Res Opin. 1997;13:593–601. doi: 10.1185/03007999709113333. [DOI] [PubMed] [Google Scholar]