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).
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