Literature Highlight: Erythromycin versus Neomycin in the Treatment of Hepatic Encephalopathy

Hepatic encephalopathy (HE) is a common complication in patients with hepatic cirrhosis. Ammonia from intestinal overgrowth with bacteria is the main cause of HE symptoms. Treatment of intestinal bacterial overgrowth with antibiotics that have low gastrointestinal absorption demonstrates the most benefit. However, increasing gastrointestinal motility is another integral part of treatment and currently used antibiotics, such as neomycin, lack this ability. To date, no treatment modalities treat bacterial overgrowth and increase motility. Erythromycin is an oral antibiotic that has been used as a pro-kinetic agent and has the potential to work on both aspects of HE.