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Lactulose has been the mainstay treatment for hepatic encephalopathy (HE). Recently, rifaximin, a nonabsorbable antibiotic, was shown to be more effective than placebo in treating HE (NEJM JW Gastroenterol Mar 11 2011). What is the benefit of combining lactulose and rifaximin?
To find out, investigators conducted a prospective, double-blind, randomized, controlled trial of lactulose (3 times per day and titrated to produce 3 soft stools per day) with or without rifaximin (400 mg 3 times per day) in 120 patients with overt HE (mean Child-Pugh score, 9.7; model for end-stage liver disease score, 24.6). At the time of hospital admission, the percentages of patients with grade 2, 3, and 4 HE were 18.3%, 33.3%, and 48.3%, respectively.
Patients wh…