Comparison between neomycin and lactulose in 173 patients with hepatic encephalopathy

Abstract

A randomized study was performed in order to compare the course of hepatic encephalopathy in patients treated with neomycin plus magnesium sulfate or with lactulose. Admission criteria were: morphological diagnosis of cirrhosis and absence of comorbidity, of contraindications to drugs, or of previous treatments which could influence the outcome. The treatment groups were similar in terms of clinical characteristics, fatalities, recovery rate from grade 1 encephalopathy, and disappearance rate of neuropsychiatric signs. Transitions from severe to grade 1 or 0 encephalopathy showed a 0.17 (NS) difference in favor of neomycin. Early therapy and evidence of precipitating factors showed a favorable prognostic significance. Ascites, hyperbilirubinemia, poor nutritional state, and hypoprothrombinemia showed bad prognostic significance. This is the first large-scale investigation on hepatic encephalopathy. It demonstrated a similar effectiveness of the two drugs in grade 1 encephalopathy and provides a basis for drug selection in the current management of the syndrome.

Management of Hepatic Encephalopathy: Focus on Antibiotic Therapy

“…The aminoglycoside neomycin has been reported to be as effective as the non-absorbable disaccharide lactulose [31, 32]. Similar evidence has been achieved using different antimicrobials, such as paromomycin, ampicillin, metronidazole [33,34,35,36,37] (table 4).…”

204 Nonabsorbable disaccharides for hepatic encephalopathy: A systematic review of randomised trials

“…All trials were described as randomised, but adequate generation of the allocation sequence was described in only four. 22 30 We classified nine trials as high quality. 5 6 20-23 30 36 39 Lactulose or lactitol v placebo or no intervention Ten trials with 280 patients (75% men) assessed lactulose or lactitol versus placebo or no intervention (table 1).…”

Considerations on the Impact of Hepatic Encephalopathy Treatments in the Pretransplant Setting

“…Neomycin has also been reported to have similar or slightly greater efficacy on several HE outcome measures compared with lactulose in two additional studies (I) (53,54), but comparable efficacy cannot be concluded due to inadequate study designs. The largest study comparing neomycin (nϭ82) with lactulose (nϭ91) showed no difference between the two treatments for transition from severe to grade 1 or 0 encephalopathy (I) (55). One small study that compared the efficacy of metronidazole with neomycin in 18 patients with mild, moderate, or severe HE showed that both antibiotics improved mental state, reduced asterixis, and improved EEG measures, but neither reduced mean blood levels of ammonia (I) (56).…”