A 58-year-old man with cirrhosis has had two discrete episodes of overt hepatic encephalopathy in the past 6 months despite good adherence to lactulose. He is currently free of encephalopathy. What is the most appropriate addition to prevent further episodes?
- A Prophylactic propranolol
- B Neomycin 500 mg twice daily
- C Rifaximin 550 mg twice daily ✓
- D Albumin infusion every 2 weeks
Correct answer: C. Rifaximin 550 mg twice daily
Explanation
After a second episode of overt encephalopathy, secondary prophylaxis with rifaximin added to lactulose reduces recurrence risk and is supported by randomised trial data. Neomycin was historically used but chronic use risks ototoxicity and nephrotoxicity, so it is no longer preferred. Propranolol prevents variceal bleeding, not encephalopathy. Albumin infusions are used in SBP and large-volume paracentesis, not for encephalopathy prophylaxis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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