Table 8.

Oral antibiotics in hepatic encephalopathy.

Neomycin	There are no well-designed studies Long-term use limited by nephrotoxicity and ototoxicity Chronic hepatic encephalopathy: 1–4 g/day Acute hepatic encephalopathy: 1–2 r every 4–6 hours
Metronidazole	Not approved for hepatic encephalopathy Side effects: neurotoxicity and gastrointestinal disturbances. Oral dose: 250 mg every 12 hours
Rifaximin	Multiple studies have demonstrated safety and efficacy for the treatment of acute and chronic encephalopathy Two trials compared rifamixine versus rifamixin with lactulose and lactitiol and suggested that rifamixin produces equal or superior improvement of ammonia levels and hepatic encephalopathy in shorter time