Abstract
Antibiotics were introduced as a therapy for hepatic encephalopathy (HE) decades before lactulose came into picture. The basic premise for the improvement of HE with antibiotics was simply that this therapy reduced ammonia generation in the gut from enteric bacteria. Neomycin was one of the first antibiotics to be employed in clinical trials in the 1950s. In addition to action on enteric bacteria, neomycin was thought to inhibit intestinal glutaminase enzymes, thereby reducing the generation of ammonia in the gut. When antibiotics have been compared to nonabsorbable disaccharides, there is a trend in favor of greater efficacy of antibiotics. However, the toxicity of many antibiotics used in the past was felt to outweigh the possible superiority of this form of treatment. Recently, Rifaximin, a nonabsorbable antibiotic, has shown great efficacy in preventing recurrent episodes of HE in patients on lactulose therapy with minimal side effect profile.
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Mullen, K.D., Prakash, R.K. (2012). Antibiotic Treatment for Hepatic Encephalopathy. In: Mullen, K., Prakash, R. (eds) Hepatic Encephalopathy. Clinical Gastroenterology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-61779-836-8_12
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DOI: https://doi.org/10.1007/978-1-61779-836-8_12
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