Table 2.

Antibiotic use in hepatic encephalopathy.

Antibiotic Use in Hepatic Encephalopathy
Antibiotic	Spectrum of Activity and Mechanism of Action	Dosage
Rifaximin	Active against Gram-positive, Gram-negative, and anaerobic enteric bacteria Binds DNA-dependent RNA polymerase and disrupts RNA synthesis	550 mg orally every 12 h or 400 mg orally every 8 h Better results if coupled with lactulose
Neomycin	Active against most Gram-negative aerobes, except some pseudomonas strains, and against S. aureus and E. faecalis. Inhibits bacterial protein synthesis via binding to the bacterial 30S ribosomal subunit, causing misreading and premature termination of mRNA translation	Acute episode: 1 g orally every 6 h for up to six days Chronic use: 1–2 g orally daily
Metronidazole	Active against anaerobic bacteria, protozoa, and microaerophilic bacteria Inhibits protein synthesis by interacting with DNA and causing helical DNA structure and strand breakage loss	No more recommended to manage the acute episode or chronic management of HE
Vancomycin	Active against Gram-positive bacteria, including MRSA: effective for Streptococci, Enterococci, and methicillin-susceptible Staphylococcus aureus (MSSA) infections Inhibits the polymerization of peptidoglycans in the bacterial cell wall