Neomycin and metronidazole can be useful in the management of encephalopathy that is poorly responsive to dietary protein restriction and lactulose. In spite of its poor GI absorption, prolonged usage of neomycin carries a risk of otovestibular injury and nephrotoxicity. Its efficacy in encephalopathy is similar to lactulose. We suggest starting doses of 1 to 2 g/d and gradually reduce to a minimum necessary to control encephalopathic symptoms. Metronidazole (750 mg/d), vancomycin, and rifaximin are other antibiotics which could be used instead of neomycin. Rifaximin, in particular, was found to be as effective as lactitol in a recent double blind controlled clinical trial. Bacterial resistance and long term toxicity are the main limitations of prolonged use of antibiotics for hepatic encephalopathy.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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