 Non absorbable antibiotics neomycin, metronidazole, and paromomycin are traditional antibiotics for the treatment of HE 12. Due to ototoxic and nephrotoxic side effects, neomycin is now used infrequently. Metronidazole does not cause much side effects but therapy should not extend beyond two weeks to avoid neuropathy. More recently rifaximin has demonstrated to be as good as lactulose 13 or lactitol 14, 15 for patients with hepatic encephalopathy. 