Rifaximin's role in hepatic encephalopathy management is to

• A. Promotes gut excretion of ammonia
• B. Inhibit gut bacteria that produce ammonia
• C. Increase renal clearance of ammonia
• D. Reduce intestinal absorption of ammonia

Answer: (B)

Rifaximin reduces hepatic encephalopathy by decreasing ammonia production in the gut. It is a nonabsorbed antibiotic that stays in the intestinal tract and inhibits the bacteria responsible for producing ammonia, which lowers the amount of ammonia available to be absorbed into the bloodstream. This targeted action addresses the root source of the problem—bacterial ammonia generation—without affecting renal clearance or directly increasing excretion. While lactulose traps ammonia and reduces absorption, rifaximin's primary benefit is cutting down how much ammonia the gut bacteria produce.