In this meta-analysis comparing rifamixin to non-absorbable disaccharides (of which only 5 controlled trials met quality criteria), researchers determined rifamixin was no more effective than non-absorbable disaccharides in treating hepatic encephalopathy (abstract). Although limited by small sample size (only 264 total patients), this is the best evidence to date for first line disaccharides, then rifamixin for failure to improve (given their higher cost).
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.