Lactulose is widely used for treatment of hepatic encephalopathy because it is effective, cheap, and widely available.  So is there any benefit to using Rifaximin in patients with hepatic encephalopathy?

Here are some questions to answer when reviewing this article

• Clinical Question: Is the addition of rifaximin to lactulose more effective than lactulose alone in the treatment of hepatic encephalopathy?
• What are the grades of hepatic encephalopathy?
• Are the patients in this study similar to your patients?
• Which patients might benefit most from the addition of rifaximin?