Level 2: Mid-level evidence

Hepatic encephalopathy is a common complication of liver cirrhosis, often requiring hospitalization. A recent trial evaluated the efficacy of rifaximin to maintain remission in 299 patients with recurrent hepatic encephalopathy due to chronic liver disease. Patients were randomized to rifaximin 550 mg twice daily vs. placebo for six months. Lactulose use was continued in patients receiving it at baseline (91%). Rifaximin was associated with reduced recurrence of encephalopathy (22.1% vs. 45.9%, P <0.001, NNT 4). There was also a lower rate of hospitalization for hepatic encephalopathy in patients treated with rifaximin (13.6% vs. 22.6%, P=0.01, NNT 9). Both groups had high rates of minor adverse events (80% vs. 79.9%). The most common adverse events were nausea, diarrhea, and fatigue (N Engl J Med. 2010;362:1071-1081). n