Intended for healthcare professionals


Neomycin should not be used to treat hepatic encephalopathy

BMJ 2001; 323 doi: (Published 28 July 2001) Cite this as: BMJ 2001;323:233
  1. Walter H Curioso, medical student,
  2. Klaus E Monkemuller, chief of gastrointestinal endoscopy, Veteran Affairs Medical Center
  1. Universidad Peruana Cayetano Heredia, Apartado 4314, Lima-100, Peru
  2. University of Alabama at Birmingham, Birmingham, AL 35294, USA

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


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