Antibiotics can be also used to inhibit intestinal ammonia
production and absorption. Rifaximin prevents recurrent
hepatic encephalopathy over a 6-month period128 and is better
tolerated than nonabsorbable disaccharides.129 Neomycin
has been found to be similar in efficacy to lactulose,130 but
also to placebo.131 However, the alteration in gut flora due to
antibiotics use is a concern