Hepatic encephalopathy due to
cirrhosis is frequently precipitated by exogenous factors, and the effectiveness of a specific treatment with
neomycin sulfate has so far not been submitted to clinical trials. Over a period of five years, 102 cirrhotic patients developed
hepatic encephalopathy at admission or during hospitalization, and 39 were randomized for treatment with either
neomycin sulfate or placebo. Exclusion criteria were: 1. current usage of specific treatment for
hepatic encephalopathy, 2. chronic
hepatic encephalopathy and 3.
multiple organ failure syndrome associated with
hepatic encephalopathy. The group of excluded patients (n = 63) was compared with the randomized group (n = 39), and no statistical differences were found regarding sex and age distributions, Child-Pugh classification, etiology of
cirrhosis, percipitating factors and grade of
hepatic encephalopathy. These same parameters were also comparable among the 20 patients who received active
neomycin and the 19 who were treated with placebo. The
therapy for
hepatic encephalopathy consisted in the control of precipitating factors associated with 6 g of
neomycin sulfate "per os" or placebo. Therapeutic failure and death by the fifth day of treatment, occurred in four patients (10.2%), two in each of the randomized groups. The time elapsed between the initiation of the therapeutic procedure and regression to grade zero of
hepatic encephalopathy was 39.11 +/- 23.04 hours for the group of active
neomycin, and 49.47 +/- 21.92 hours for the placebo group, but this difference did not achieve statistical significance.