Some research indicates that the oral antibiotic ofloxacin may be as effective and without complications, allowing patients to be treated at home. In advanced cirrhosis, the risk for serious abdominal infection is high and the antibiotic norfloxacin is often prescribed preventively against specific organisms that infect the abdominal cavity. One study found that preventive antibiotics were very cost effective in high-risk patients. Another study reported, however, that patients who took norfloxacin became susceptible to Staphylococcal infections, which are not ordinarily a problem in cirrhosis, and their survival rates were similar to patients who did not take the antibiotic. Long-term treatments with norfloxacin or similar antibiotics may increase the risk for fungal infections after liver transplantation.
More research is needed.
The first step in managing encephalopathy is to treat any precipitating cause, if known, such as bleeding, high ammonia levels, low oxygen, infection, dehydration, or use of sedatives. Mild encephalopathy is managed by directing therapy toward eliminating ammonia in the intestine. The first step is to restrict animal protein, substituting meats and dairy products with vegetable protein, such as soy, and amino acid supplements. Enemas, which clean out the intestine, may be effective. Adding non-ammonia producing bacteria, including L. acidophilus and E. faecium, to the intestine is showing promise as a safe and effective treatment.