Which treatment is best for hepatic encephalopathy due to end-stage liver disease?

EVIDENCE-BASED ANSWER Rifaximin is as effective as other antibiotics or oral disaccharides for improving hepatic encephalopathy with a better safety profile (SOR: A, meta-analysis of RCTs). Combination therapy of rifaximin and lactulose is more effective for reversal of hepatic encephalopathy with less mortality than lactulose alone (SOR: B, RCT). Prophylactic use of rifaximin plus lactulose reduces hospitalizations for hepatic encephalopathy more than lactulose alone (SOR: B, RCT).