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Amoxicillin-Clavulanate, Before a Meal May Improve Small Bowel Motility

Discussion in 'Other Health News and Research' started by Waverunner, May 1, 2012.

  1. Waverunner

    Waverunner Senior Member

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    A treatment option for SIBO which has benefits beyond its antibacterial effect. More motility should equal less bacterial growth in the small intestine. If more motility can lead to a decrease in intestinal permeability, still needs to be determined. Resistance remains a problem, however.

    http://www.sciencedaily.com/releases/2012/04/120430114945.htm

    ScienceDaily (Apr. 30, 2012) The common antibiotic, amoxicillin-clavulanate, may improve small bowel function in children experiencing motility disturbances, according to a study appearing in the June print edition of the Journal of Pediatric Gastroenterology and Nutrition from Nationwide Children's Hospital.

    Amoxicillan-clavulanate, also known as Augmentin, is most commonly prescribed to treat or prevent infections caused by bacteria. However, it has also been reported to increase small bowel motility in healthy individuals and has been used to treat bacterial overgrowth in patients with chronic diarrhea.
    Upper gastrointestinal symptoms such as nausea, vomiting, abdominal pain, early satiety and abdominal distention are common in children. Despite the advances in the technology for diagnosing motility disorders, there continues to be a lack of medications available for the treatment of upper gastrointestinal tract motor function.
    "There is a significant need for new drugs to treat upper gastrointestinal symptoms in children," said Carlo Di Lorenzo, MD, chief of Gastroenterology, Hepatology and Nutrition at Nationwide Children's Hospital and one of the study authors. "Currently used drugs are often only available on a restricted basis, have significant side effects or aren't effective enough on the small and large intestine."
    To examine whether amoxicillin-clavulanate might serve as a new option for treating upper gastrointestinal tract motor function, investigators at Nationwide Children's examined 20 patients who were scheduled to undergo antroduodenal manometry testing. After catheter placement, the team monitored each child's motility during fasting for at least three hours. The children then received one dose of amoxicillin-clavulanate enterally, either one hour before ingestion of a meal or one hour after the meal and then had motility monitored for one hour following.
    The study showed that amoxicillin-clavulanate triggered groups of propagated contractions within the small intestine, similar to those observed during the duodenal phase III of the interdigestive motility process. This response occurred in most of the study participants during the first 10-20 minutes and was most evident when amoxicillin-clavulanate was given before the meal.
    "Inducing a preprandial duodenal phase III may accelerate small bowel transit, influence the gut microbiome and play a role in preventing the development of small bowel bacterial overgrowth," said Dr. Di Lorenzo.
    Dr. Di Lorenzo says that amoxicillin-clavulanate may be most effective in patients with alterations of duodenal phase III, chronic symptoms of intestinal pseudo-obstruction and those fed directly into the small bowel with gastrojejunal nasojejunal feeding tubes or surgical jejunostomy.
    Although amoxicillin-clavulanate seems to mainly affect the small bowel, the mechanisms by which it works are not clear. Dr. Di Lorenzo also says that possible downsides of using amoxicillin-clavulanate as a prokinetic agent include the induction of bacterial resistance, especially from gram negative bacteria such as E.coli and Klebsiella and causing Clostridium difficile induced colitis.
    Still, he says further investigation of amoxicillin-clavulanate's long-term benefits in gastrointestinal clinical situations is worthwhile. "The scarcity of currently available therapeutic options may justify the use of amoxicillin-clavulanate in selected patients with severe forms of small bowel dysmotility in whom other interventions have not been efficacious," he said.
  2. Enid

    Enid Senior Member

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    Very interesting Waverunner - I was put onto a high dose course of Amoxcillan after the removal of two infected roots and couldn't understand why GI issues eased too. Now I see, overgrowth of the wrong gut bacteria apparently. (Masses of Probiotics taken at recommended intervals during and after the course - things have never been quite as severe since).
  3. Waverunner

    Waverunner Senior Member

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    Hi Enid,

    Amoxicillin worked pretty well for me, too. Many other ABs didn't.
  4. beaker

    beaker CFS/ME 1986

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    For strictly motility issues small doses erthyromycin ( below AB theraputic levels) has long been used for its pro-kinetic action.
    Doses have to be finely tuned or it can work too well ;- ) . of course it can promote bacterial resistance same as augmentin per above, and is not first line choice prokinetic. It is very cheap -- much less than augmentin though.
  5. nanonug

    nanonug Senior Member

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    Actually, in the small intestine, any overgrowth is of the wrong kind of bacteria.
  6. nanonug

    nanonug Senior Member

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    Do you know what is? This is an issue I have been dealing with without much success...
  7. Waverunner

    Waverunner Senior Member

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    Thanks for the information. Can you give a little more detailed information regarding the dosing of Erythromycin? I guess women have a choice by trying Prucalopride.
  8. beaker

    beaker CFS/ME 1986

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    erthyromycin [...] is not first line choice prokinetic.

    Reglan/metrocloprimide is most commonly used.

    propulsid used to be widely used ( and works well) but was taken off the market in US due to some heart issue. However, I was told that it was only in various specific cases and dosed that could be predetermined and they jumped the gun. It is widely ( and safely) used in veterinary medicine( have to get from a compounding pharm) REcently it has been made available for humans again on the US market for special cases ( think many hoops and lots of paperwork) for those that nothing else works for.


    Have you had a gastric emptying test?
    you eat eggs made w/ a radioactive isotope and drink spiked OJ( or other liquid). then stand in front of this screen/scanner and you can watch the transit through your system. They measure the amount of time it takes. eggs are used b/c of the high fat . I had a couple. no pain. the food is awful. but it is kinda cool to watch the scanner. ( I'm easily entertained : )
    anyways. The test can help pinpoint the motility issue(s).
  9. beaker

    beaker CFS/ME 1986

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    Need to look back at my info. will be happy to dig it up for you. be back later today w/ that.
  10. nanonug

    nanonug Senior Member

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    Thanks, good to know. But isn't this for gastroparesis, mostly?

    Actually, for what I am looking for, I would love to put my hands on some tegaserod.

    I have not. But, isn't this for gastroparesis only? My pet peeve is SIBO.
  11. beaker

    beaker CFS/ME 1986

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    ____

    I think our me/cfs brain wires got crossed oops.

    I was addressing the motility(aka prokinetic) meds per that part of the discussion.


    I have not treated myself for SIBO, but I did treat my cat : ) Things that helped:
    B12 injections helped a lot, and folate, along with pro biotics and pre -biotics, metronidazole. and/or clavamox ( augmentin ) (I used them together. )
    diet ( cats are carnivores, since I had already on species appropriate diet, didn't have fiber to cut out )
  12. beaker

    beaker CFS/ME 1986

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    Ok. dug up the file. I took 250mg erythro base tablet. in the evening.
    It ended up causing me fevers and so I stopped. It was longer ago than I realized. i did a quick punch on google. most of the studies that show up are in IV dosing.
    but those I found varied quite a bit. anywhere from 50mg -330mg and anywhere from 1x day to 4x day.
    sorry I can't be more help with it.

    I found this site with a list of prokinetics. I know nothing of this organization. But the list seems about right. can't vouch for the details on the meds though.
    Hopefully it has some value for you .

    http://www.digestivedistress.com/motility-rx
  13. Waverunner

    Waverunner Senior Member

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    Thanks for looking up the information, I'll keep that in mind.

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