Neomycin should not be used to treat hepatic encephalopathy

doi:10.1136/bmj.323.7306.233

BMJ 2001;323:233 ( 28 July )

Letters

Neomycin should not be used to treat hepatic encephalopathy

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EDITOR $---$ In their clinical review on portal hypertension Krige and Beckingham mention neomycin as treatment for hepatic encephalopathy.¹Although neomycin has been used as a standard treatment of hepaticencephalopathy for almost 40 years, there is no evidence thatthe drug is effective. The only randomised, placebo controlledstudy found no benefit of neomycin compared with standard treatmentalone.² Also, the combination of neomycin with lactulose wasnot superior to placebo.³ On the basis of these negative studiesand the potential for serious adverse effects of this drug, neomycinshould not be prescribed for hepatic encephalopathy. Other antibiotics,including paromomycin, metronidazole, vancomycin, and rifaximin,are better tolerated, and several randomised controlled trialssupport their efficacy. ⁴ ⁵

Walter H Curioso, medical student.
Universidad Peruana Cayetano Heredia, Apartado 4314, Lima-100, Peru

Klaus E Monkemuller, chief of gastrointestinal endoscopy, Veteran Affairs Medical Center.
University of Alabama at Birmingham, Birmingham, AL 35294, USA

1.	Krige JE, Beckingham IJ. ABC of diseases of liver, pancreas, and biliary system: portal hypertension-2. Ascites, encephalopathy, and other conditions. BMJ 2001; 322: 416-418[Free Full Text]. (24 February.)
2.	Strauss E, Tramote R, Silva EP, Caly WR, Honain NZ, Maffei RA, et al. Double-blind randomized clinical trial comparing neomycin and placebo in the treatment of exogenous hepatic encephalopathy. Hepatogastroenterology 1992; 39: 542-545[Medline].
3.	Blanc P, Daures JP, Liautard J, Buttigieg R, Desprez D, Pageaux G, et al. Lactulose-neomycin combination versus placebo in the treatment of acute hepatic encephalopathy. Results of a randomized controlled trial. Gastroenterol Clin Biol 1994; 18: 1063-1068[Medline].
4.	Williams R, James OF, Warnes TW, Morgan MY. Evaluation of the efficacy and safety of rifaximin in the treatment of hepatic encephalopathy: a double-blind, randomized, dose-finding multi-centre study. Eur J Gastroenterol Hepatol 2000; 12: 203-208[Medline].
5.	Miglio F, Valpiani D, Rossellini SR, Ferrieri A. Rifaximin, a non-absorbable rifamycin, for the treatment of hepatic encephalopathy. A double-blind, randomised trial. Curr Med Res Opin 1997; 13: 593-601[Medline].

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