Flagyl Antibiotic Query

Hi Guys:Retro smile:

I was wondering if any of you would be able to shed some light on something thats been puzzling me for a long time.

Ive been suffering severe cfs for 19yrs and there have been precious little treatments that have given me any kind of energy or boost over that time. Whatever has worked has worked for about 2-3days and then Im back to my normal crappy self.

Ive been seeing a new doctor the past 18months and she ran many many new tests on me - blood - saliva - hair - bowel you name it she did it. One thing she discovered was that I had some parasites in my bowel.

She put me on some reeeeally potent herbal medicine for a month. During this month I felt absolutely nothing. The minute I stopped I had 3 magnicifent and WONDERFUL days - the best. And then it dissapeared and I went back to normal. The doc figured the bugs were too strong for herbals and moved on to phase II being anitbiotics.

I was put on a MAMMOTH 10 day dose of Flagyl. So large that she expected the pharmacist to query it - it made me realllly sick - I vomited and felt incredibly sick for the next 9days. I NEVER want to go through that again. However come day 10 I woke up feeling like a new woman - the wonder and amazement of that day and the next 2 to follow were like out of the movie Awakenings! I was WONDER WOMAN - I was energetic and felt amazing and for the first time in 19 hideous years I felt CURED. It was phenominal.

and then 2days later the feeling completely dissapeared and I went back to my regular couch/bed state.

The Doc was baffled by this - so much so she sent the results to a leading expert in the field of parasites and bowel health etc and he stated I felt better becuase the antibiotics had killed off anerobic overgrowth.

Does anyone have any opinions on this? I know some of you are fountains of knowledge here and I would LOVE to hear any thoughts. I want that feeling back soo bad. Is it possible if I am XMRV + that the antibiotics could have affected it a little and that its nothing to do with parasites after all?

Tembo:Retro tongue:

Hi,

What you are describing sounds a lot like Small Intestinal Bacterial Overgrowth (SIBO). Periods of diarrhea and/or constipation, abdominal bloating, gas (both kinds), lots of abdominal pain. There are a couple tests but the hydrogen/method breath test is the most available and it is reasonably reliable (duodenal tissue samples obtained via upper GI endoscopy are tricky to get without contamination and it is an involved procedure). This breath test actually serves to diagnose the existence of SIBO and assesses the efficacy of treatment.

Systemic antibiotics such as Flagyl and Cipro can have some effect but the ideal treatment is Xifaxin. A high dose for 1-2 weeks. Let me know if you'd like some literature current. Be prepared for a fight with your insurance company as not many cover Xifaxin for the necessarily repeated doses and the extended course but it is well worth it (relief for months in some cases). Over the counter costs are about $700 US.

The cause in many CFS patients in autonomic neural dysfunction that impacts small intestine motility ->constipation -> bacterial from the colon colonizing the upper small intestine -> excess gas (hydrogen and methane production and absorptive dysfunction/dysbiosis).

Good luck!

Dr. DeMeirler from belgium talks about this sometimes. You might want to google him. I'm curious what that GI expert thought got killed by the Flagyl, however. Which anaerobes does he/she think you had?

XIFAXAN and not XIFAXIN?

CBS: Did you mean XIFAXAN and not XIFAXIN? Googled for Xifaxin and it came back with the spelling of an A instead of the I at the end.

XIFAXAN. (rifaximin) Tablets
DRUG DESCRIPTION. XIFAXAN tablets contain rifaximin, a non-aminoglycoside semi-synthetic, nonsystemic antibiotic derived from rifamycin SV. Rifaximin is a structural analog of rifampin. The chemical name for rifaximin is (2S,16Z,18E,20S,21S,22R,23R,24R,25S,26S,27S,28E)*5,6,21,23,25- pentahydroxy-27-methoxy-2,4,11,16,20,22,24,26-octamethyl-2,7( epoxypentadeca-[1,11,13]trienimino)benzofuro[4,5-e]pyrido[1,2-]-benzimidazole-1,15(2H)*dione, 25-acetate. The empirical formula is C43H51N3O11 and its molecular weight is 785.9. The chemical structure is represented below:
XIFAXAN tablets for oral administration are film-coated and contain 200 mg or 550 mg of rifaximin.
Inactive ingredients: Each tablet contains colloidal silicon dioxide, disodium edetate, glycerol palmitostearate, hypromellose, microcrystalline cellulose, propylene glycol, red iron oxide, sodium starch glycolate, talc, and titanium dioxide.
Last updated on RxList: 4/19/2010

INDICATIONS. To reduce the development of drug-resistant bacteria and maintain the effectiveness of XIFAXAN and other antibacterial drugs, XIFAXAN when used to treat infection should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Travelers'Diarrhea. XIFAXAN 200 mg is indicated for the treatment of patients ( ≥ 12 years of age) with travelers' diarrhea caused by noninvasive strains of Escherichia coli [see WARNINGS AND PRECAUTIONS, CLINICAL PHARMACOLOGY and Clinical Studies].
Limitations of Use
XIFAXAN should not be used in patients with diarrhea complicated by fever or blood in the stool or diarrhea due to pathogens other than Escherichia coli.
DOSAGE AND ADMINISTRATION
Dosage for Travelers' Diarrhea: The recommended dose of XIFAXAN is one 200 mg tablet taken orally three times a day for 3 days. XIFAXAN can be administered orally, with or without food [see
HOW SUPPLIED
Dosage Forms And Strengths
XIFAXAN is pink-colored biconvex tablets and is available in the following strengths:
200 mg – a round tablet debossed with “Sx” on one side.
550 mg – an oval tablet debossed with “rfx” on one side.
Storage And Handling
The 200 mg tablet is a pink-colored, round, biconvex tablet with “Sx” debossed on one side. It is available in the following presentations:
NDC 65649-301-03, bottles of 30 tablets
NDC 65649-301-41, bottles of 100 tablets
NDC 65649-301-05, carton of 100 tablets, Unit Dose
The 550 mg tablet is a pink-colored, oval, biconvex tablet with “rfx” debossed on one side. It is available in the following presentations:
NDC 65649-303-02, bottles of 60 tablets
NDC 65649-303-03, carton of 60 tablets, Unit Dose
Storage
Store XIFAXAN Tablets at 20–25C (68–77F); excursions permitted to 15–30C (59-86F). See USP Controlled Room Temperature.
Manufactured for: Salix Pharmaceuticals, Inc., Morrisville, NC 27560, under license from Alfa Wassermann S.p.A. Web site: www.Salix.com, E-mail: customer.service@salix.com, 1700 Perimeter Park Drive, Morrisville, NC 27560, Tel.866-669-SLXP (7597).
Last updated on RxList: 4/19/2010

CLINICAL PHARMACOLOGY
Mechanism of Action. Rifaximin is an antibacterial drug.
Travelers' Diarrhea
Systemic absorption of rifaximin (200 mg three times daily) was evaluated in 13 subjects challenged with shigellosis on Days 1 and 3 of a three-day course of treatment.
Rifaximin plasma concentrations and exposures were low and variable. There was no evidence of accumulation of rifaximin following repeated administration for 3 days (9 doses). Peak plasma rifaximin concentrations after 3 and 9 consecutive doses ranged from 0.81 to 3.4 ng/mL on Day 1 and 0.68 to 2.26 ng/mL on Day 3. Similarly, AUC0-last estimates were 6.95 5.15 ng•h/mL on Day 1 and 7.83 4.94 ng•h/mL on Day 3. XIFAXAN is not suitable for treating systemic bacterial infections because of limited systemic exposure after oral administration [see WARNINGS AND PRECAUTIONS].

My autistic son as well as myself and his little brother, all suffer from anaerobic bacterial overgrowth. And yes, Flagyl IS miraculous for us. Concerning the vomitting: Flagyl is absolutely incompatible with alcohol, that will result in vomitting. Another thing is while on Flagyl, we always take a prescription antifungal at the same time, Diflucan or Ketoconazole. Because if you really have bacterial overgrowth, the large amount of die-off while on Flagyl will flare the yeast. That's another possibility for adverse reaction: flare of yeast, and/or bacterial die-off.

Now if Flagyl helps and bacterial overgrowth seems to be a problem indeed, then I highly recommend going on a low starch low carb diet. That IS what is going to prevent this from happening. Otherwise, the bacteria grow right back if you keep supplying them with a large amount of food (starch). This kind of diet is mainly vegetables (no potatoes), fruits, nuts, oils, meat, eggs, lentils, peas, navy and lima beans (no other beans). To replace pasta, I use spaghetti squash, to replace potatoe fries I use butternut squash, and to replace rice I use lentils. To replace flour I use almond flour (in moderation).

Here are a couple of books I highly recommend:

http://www.amazon.com/Breaking-Vicious-Cycle-Intestinal-Through/dp/0969276818
http://www.amazon.com/Gluten-Free-Almond-Flour-Cookbook/dp/158761345X



Now if you start such a diet cold-turkey, be prepared for awful die-off for a couple weeks. That's why it is good to set a time, e.g. I will do it 30 days no matter what, and if after 30 days I don't feel better then maybe this is not for me. In my case, die-off lasted 23 days (I counted). Honestly, I almost gave up.

CBS: Thanks for the info you provided. I, several of my friends and family, have had a long-term bout of major GI issues that sound just as you provided. I and my best friend's husband even had colonoscopies done because our GI doctors could not figure out what was wrong. All I wanted from my GI doctor was Flagyl since I figured I had gotten sick from three different antibiotics (for lung infection) and I had either/and/or C.diff (antibiotics) or maybe Giardia lamblia (from a new, badly abused rescue hound my husband and I picked up off the road and took to the ER Vet). The GI doc insisted I go through the colonoscopy but nothing was found except for an odd red patch (which she thought MAY be an infection). NO inflammation which is odd since I was diagnosed with the funky named "Atypical Crohn's Disease" and always presented with gross inflammation in the colon and the biopsies.

I might ask the GI doc for Rifaximin since it sounds to me like it may well help. I was told by my hair stylist that she had several other clients with the exact same issue. I thought it may be an infection (viral or bacterial or both) and not the Giardia since I had a horrid case of Giardia in grad school and the symptoms were very different.

Anyway, thanks CBS for the scoop on Rifaximin. My issues are now at week 10 and my best friend's husband's issues are at week 12 (and we have not seen eachother). My sister, BIL, and niece also now have this problem and are at week 4, with the BIL being very sick with it. I DID stay with them and was sick three days after getting to their home. Have to wonder if I did not give them my problem.

Flagyl info; Great drug

I was put on Flagyl for my Giardia for several weeks. It knocked it out. However, I recall that it also knocks out ALL the flora (bad and good) in the GI. It may be wise to use probiotics after taking the Flagyl. Culturelle (Lactobaccilius GG) was helpful in getting the good flora back into the system.
One more caveat: I, my sister/BIL and my best friend's husband all took a great deal of the Culturelle thinking we would knock out our GI issue (See above GI issue discussion). It may well have made the situation worse. I say that only because it was the one thing we all had in common with eachother.
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http://www.medicinenet.com/metronidazole/article.htm
Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD

GENERIC NAME: metronidazole
BRAND NAME: Flagyl
DRUG CLASS AND MECHANISM: Metronidazole is an antibiotic effective against anaerobic bacteria and certain parasites. Anaerobic bacteria are single-celled, living organisms that thrive in environments in which there is little oxygen (anaerobic environments) and can cause disease in the abdomen (bacterial peritonitis), liver (liver abscess), and pelvis (abscess of the ovaries and the Fallopian tubes). Giardia lamblia and ameba are intestinal parasites that can cause abdominal pain and diarrhea in infected individuals. Trichomonas is a vaginal parasite that causes inflammation of the vagina (vaginitis). Metronidazole selectively blocks some of the functions within the bacterial cells and the parasites resulting in their death.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Tablets: 250 and 500 mg. Tablets, extended release: 750 mg. Capsule: 375 mg. Cream: 0.75% and 1%. Lotion: 0.75%. Gel: 0.75% and 1%. Injection: 5 mg/ml

STORAGE: Metronidazole should be stored at room temperature and protected from light.

PRESCRIBED FOR: Metronidazole is used to treat parasitic infections including Giardia infections of the small intestine, amebic liver abscess and amebic dysentery (infection of the colon causing bloody diarrhea), bacterial vaginosis, trichomonas vaginal infections, and carriers of trichomonas (both sexual partners) who do not have symptoms of infection. Metronidazole is also used alone or in combination with other antibiotics in treating abscesses in the liver, pelvis, abdomen and brain caused by susceptible anaerobic bacteria. Metronidazole is also used in treating infection of the colon caused by a bacterium called C. difficile. (Many commonly-used antibiotics can alter the type of bacteria that inhabit the colon. C. difficile is an anaerobic bacterium that can infect the colon when the normal types of bacteria in the colon are inhibited by common antibiotics. This leads to inflammation of the colon (pseudomembranous colitis) with severe diarrhea and abdominal pain.) Metronidazole also is used in combination with other drugs to treat Helicobacter pylori (H. pylori) that causes stomach or intestinal ulcers. Metronidazole topical gel is used for treating acne rosacea, and the vaginal gel is used for treating bacterial vaginosis.

DOSING: Metronidazole may be taken orally with or without food. In the hospital, metronidazole can be administered intravenously to treat serious infections. The liver is primarily responsible for eliminating metronidazole from the body, and doses may need to be reduced in patients with liver disease and abnormal liver function.

Various metronidazole regimens are used. Some examples are listed below.

Amebic dysentery: 750 mg orally 3 times daily for 5-10 days


Amebic liver abscess: 500-750 mg orally three times daily for 5-10 days


Anaerobic infections: 7.5 mg/kg orally every 6 hours not to exceed 4 grams daily


Bacterial Vaginosis: 750 mg (extended release tablets) once daily for 7 days. One applicator-full of 0.75% vaginal gel, once or twice daily for 5 days.


Clostridium difficile infection: 250-500 mg orally 4 times daily or 500-750 orally 3 times daily


Giardia: 250 mg orally three times daily for 5 days


Helicobacter pylori: 800-1500 mg orally daily for several days in combination with other drugs.


Pelvic inflammatory disease (PID): 500 mg orally twice daily for 14 days in combination with other drugs.


Trichomoniasis: 2 g single dose or 1 g twice


Rosacea: apply topical gel 0.75-1% once daily

Xifaxan may also treat skin disorder Rosacea. Just an odd thing I saw, curious though

Gut Bacteria and Xifaxan get some press coverage
April 30th, 2010, by David Pascoe | rosacea cause
The St. Louis-Dispatch has an article today exploring the link between the overgrowth of small intestinal bacteria and rosacea symptoms for some rosacea sufferers.

New way to treat skin disorder
By Cynthia Billhartz Gregorian, ST. LOUIS POST-DISPATCH, 04/29/2010

Weinstock is not a dermatologist. Hes a founding partner of Specialists in Gastroenterology in Creve Coeur.
Nevertheless, word has spread that hes had success treating the skin disorder, rosacea, with a drug typically used to treat gastrointestinal issues caused by small intestinal bacterial overgrowth commonly known as SIBO.
Whats gaining ground is this theory that irritable bowel syndrome is related to rosacea," Weinstock said.
Weinstock was studying the link between restless leg syndrome and small intestinal bacterial overgrowth, a couple of years ago, when he read a published study in a medical journal, linking rosacea to small intestinal bacterial overgrowth.
About six months ago, he decided to conduct his own in-office study.
When he noticed signs of the condition on patients that he was treating for gastrointestinal issues, hed ask them to take a lactulose breathing test which assesses bacterial overload in the small intestines.
Eight of 13 patients tested positive for SIBO. After treating them with Xifaxan for 10 days, five were markedly better, one was slightly improved and two were unchanged.
Dr. Weinstock found that his study matched the findings of the published study from the University of Genoa.
A colleague of Dr. Weinstock, Dr. Anna Glaser, warns that the results are interesting but larger, more comprehensive trials are required to uncover the extent of this discovery. Dr. Weinstock also mentions that Xifaxan (brand name for rifaximin 200mg) wont work for all cases of rosacea because not all cases are caused by small intestinal bacterial overload.

At the end of the article we are told about a possible source conflict relating to Dr. Weinstock;
Weinstock, an associate professor of clinical medicine and surgery at Washington University, did disclose that he is a member of the speakers bureau at Salix Pharmaceuticals, which makes Xifaxan.
For more information about about Xifaxan see the drug information: Nonsystemic Xifaxan. The most common side effects were flatulence, headache and abdominal pain which you would associate with the main intended condition rifaximin targets anyway travellers diarrhea.
This topic has attracted a lot of interest in the online rosacea forums. The link between SIBO and the papules and pustules of rosacea is still a mystery. The researchers responsible for the discovery that has sparked this interest conclude with;

SIBO eradication clears rosacea: are you serious ?
The clearance of cutaneous lesions in almost all rosacea patients after its eradication strongly suggests that SIBO plays a significant pathogenetic role in rosacea, expecially in its papulopustular component. Although the underlying mechanisms linking SIBO to the cutaneous lesions of rosacea need to be elucidated, we believe that our findings represent paramount progress in the clinical management of those frustrated patients.

Muffin,

My bad on the spelling. Let's just stick with Rifaximin (brand name:Xifaxan). It is my understanding that Rifaximin is not effective against C.Diff. I don't think you can spread this in an infectious manner (at least that's not the case for me, mine is caused by neural dysfunction and lost motility). If you can get access to a hydrogen breath test it will confirm the overgrowth and can be used to monitor treatment.

In my case, I have periods of autonomic dysfunction when the peristalses in my small intestine is insufficient to keep everything "moving down stream." That leads to a period of constipation and pain (may last a few days to weeks). The bacteria normally limited to the colon now have a chance to head "up stream" and colonize the small intestine. You gut isn't design for this and all hell breaks loose. Gas, bloating, more pain, diarrhea, GERD. Tons of gut sounds (nearly constant rumbling). Sugars really set things off as the bacteria, now in just over running the small intestine love the stuff. Big meals make things worse as do anything that's hard to digest (fats, steak, etc. - impaired motility is what got all of this started).

There are a couple reasons that my GI prefers Xifaxan. First, it is non-systemic. Very little of the antibiotic crosses the gut into the blood stream. This significantly reduces side effects. It also reduces the probability of developing a systemic antibiotic resistant bacterial infection. This last point is particularly important because if, like mine, your SIBO is caused by autonomic neural dysfunction this is not a fix, it treating an important dysbiosis that is a result of a larger issue.

I have found for myself that diet (composition and size of meal), some mild activity (even just doing a few half hearted-stomach crunches) to assist the gut, minimizing anything that triggers neural symptoms, and to the degree possible, minimizing meds that interfere with motility (esp. opiates and some neural meds - eg. Xanax) helps to prolong the period that i am free of SIBO. I also take a probiotic twice every day (florastor). As I learn more ways to keep this at bay, the periods between bouts of SIBO seem to be getting longer. That's a good thing for your body and your pocket book as Xifaxan can be expensive and it is usually a fight requiring a supportive doctor and lots of documentation to get it insurance to pay for it in the treatment of SIBO (another good reason for a hydrogen/methane breath test).


Good luck.

Prof. Garth L. Nicolson-mycoplasmal infections (look into this for GI issues)

When I first had CFIDS I had the worst GI issues possible. In that bathroom up to 20 times a day and in pain with spasms so bad I thought a bomb was exploding. My father read about Mycoplasmas and told me to get on a course of at last six months of Doxycycline. I forced my internist to write the prescription for Doxy and within that six month period the horrible GI issue went away. It really was so horrendous that I would just lay in a ball on the bed waiting for the next spasm or trip to the bathroom. My internist said the Doxy reduced the inflammation. Nice try, but the Doxy knocked out the horrendous part for the next 12 years. Now of course I am into something different. But, you might ask for a good six months of Doxy. Great all purpose antibiotic with no side-effects at all for ME. However, recently an ER doc told me that about 97% of the pop is resistent to Doxy from overuse of antibiotics. But, it won't hurt to ask and it won't hurt to try, in my opinion. See Garth Nicholson's info on Mycoplasmas. His stuff is old now, but I am a big believer in the Mycoplasma infection as part of CFIDS and many other diseases. http://www.immed.org/ CFIDS discussion from his site below;

Chronic Fatigue Illnesses------Prof. Garth L. Nicolson
Chronic Fatigue Syndrome, Fibromyalgia Syndrome and Other Fatigue Conditions

Chronic fatigue is reported by 20% of all patients seeking medical care and is considered as a nonspecific sign that is associated with many well known medical conditions. Chronic Fatigue Syndrome (CFS), Myalgic Encephalomyelitis (ME), and Fibromyalgia Syndrome (FMS) patients suffer from complex overlapping signs and symptoms. (see 'Signs/Symptoms' Questions, above) CFS is primarily characterized by persisting or relapsing fatigue without previous history of comparable symptoms that does not resolve with rest. In these patients other clinical conditions are absent that can explain the signs and symptoms such as malignancies or autoimmune diseases. In contrast, FMS patients have overall muscle pain, tenderness, and weakness as primary complaints, but they have most if not all of the commonly found signs and symptoms for CFS. We previously proposed that CFS/ME patients might be suffering from chronic infections that can cause, in part, their complex signs and symptoms. For example, systemic mycoplasmal infections can cause chronic fatigue, muscle pain and a variety of additional signs and symptoms, some of which are related to dysfunctional immune responses and in extreme cases autoimmune-like disorders. Some mycoplasmas can invade virtually every human tissue and can compromise the immune system, permitting opportunistic infections by other bacteria, viruses, fungi and yeast. When mycoplasmas exit certain cells, such as synovial cells, nerve cells, among others that can be infected, they can stimulate autoimmune response. Our recently published studies demonstrated a possible link between mycoplasmal infections and CFS and FMS, since we found high frequencies of mycoplasmal infections in these patients. Previously we examined patients with chronic illnesses for the presence of mycoplasmal infections. We found that about one half of patients with Gulf War Illness and two third of patients with CFS/ME and FMS were positive for mycoplasmal infections in their blood. The Gulf War Veterans suffer from signs and symptoms similar to patients diagnosed with CFS and FMS. They can be treated using antibiotics effective against mycoplasmal infections, and once they recover, their blood is no longer positive for the presence of mycoplasmal infections. Our recent results indicate that Rheumatoid Arthritis is also associated with mycoplasmal infections. (see 'Autoimmune Diseases')
Recent reports and publications indicate that in addition to mycoplasmal infections, CFS/ME and FMS patients have other chronic infections caused by other intracellular bacteria and viruses. For example, patients with Lyme Disease, caused by intracellular Borrelia infections, have been diagnosed with CFS/ME. Also, CFS/ME and FMS patients can have intracellular Chlamydia species infections. These patients can also have infections by other bacteria that enter their bodies through 'leaky gut' problems. Chronically ill patients often have inflammatory bowel syndrome and other gut problems, and this can allow pathogenic bacteria to enter their systems.

Patients with CFS/ME and FMS can also have viral infections that complicate their conditions and cause morbidity. Such infections can occur with or without the bacterial infections described above. Viruses that have been associated with CFS/ME and FMS are Human Herpes Virus-6 (HHV-6) and Cytomeglovirus (CMV). These viruses have been found at high incidence in chronically ill patients, and especially those with CFS/ME. Patients with CFS/ME or FMS can have predominantly intracellular bacterial infections, predominantly viral infections, or a combination of intracellular bacterial and viral infections. This may be one reason why the underlying causes of these chronic illnesses are so difficult to determine and effectively treat. The other reason could be the persistent nature of the infections and their ability to hide inside cells where they are essentially refractory to immune system responses, their slow growing natures and their relative insensitivity to therapeutic drugs (see references below).

A new direction at the Institute is studying the role of decreased cellular energy in causing fatigue. Cellular energy is mainly produced by the mitochondria, subcellular organelles that contain the machinery that converts fats and sugars to energy in the form of the high-energy molecules, such as ATP. Mitochondrial function requires an intact inner membrane where the electron transport chain or energy machinery is located. When the inner mitochondrial membrane is damaged, the efficiency of the electron transport chain is reduced along with the ability of cells to produce the energy that they need for vital functionsthus fatigue becomes a problem. Various environmental insults and even aging produce excess oxidation molecules that can damage the mitochondrial membrane, including chronic infections of the type mentioned above. At the Institute for Molecular Medicine clinical studies have shown the benefits of dietary membrane lipids (Lipid Replacement Therapy) in replacing damaged mitochondrial membrane lipids, increasing the efficiency of the electron transport chain, increasing energy and reducing fatigue. A number of non-pharmaceutical approaches to decreasing fatigue are being investigated at the Institute.

Publications

Chronic Fatigue Syndrome Patients Subsequently Diagnosed with Lyme Disease Borrelia burgdorferi: Evidence for Mycoplasma species Co-Infections - by Garth L. Nicolson, PhD, Nancy L. Nicolson, PhD and Joerg Haier, MD, PD, Journal of Chronic Fatigue Syndrome 2008; 14(4):5-17. - rtf_doc

Metabolic Syndrome and Mitochondrial Function: Molecular Replacement and Antioxidant Supplements to Prevent Membrane Peroxidation and Restore Mitochondrial Function, Garth L. Nicolson, Journal of Cellular Biochemistry 2007; 100: 1352-1359. pdf doc

Considerations when Undergoing Treatment for Chronic Illnesses and Autoimmune Diseases, by Prof. Garth L. Nicolson, Reprint - Intern. J. Medicine 1998; 1:123-128. Plus Supplemental Suggestions: Prof. Nicolson June 15, 2006. rtf doc

Lipid replacement and antioxidant nutritional therapy for restoring mitochondrial function and reducing fatigue in chronic fatigue syndrome and other fatiguing illnesses, by Nicolson and Ellithorpe, Journal of Chronic Fatigue Syndrome 2006; 13(1): 57-68. pdf doc

Lipid replacement/antioxidant therapy as an adjunct supplement to reduce the adverse effects of cancer therapy and restore mitochondrial function, by Prof. Nicolson, Pathology & Oncology Research 2005; 11(3): 139-144. pdf doc

Evidence for Brucella spp. And Mycoplasma ssp. Co-Infections in Blood of Fatigue Syndrome Patients, by Nicolson et al., Journal of Chronic Fatigue Syndrome 2005; 12(2): 5-17. rtf doc

Deregulation of the 2.5A synthetase RNase L antiviral pathway by Mycoplasma spp. in subsets of Chronic Fatigue Syndrome By J. Nijs et al., J. Chronic Fatigue Syndr. 2003; 11(2):37-50. rtf doc

Multiple co-infections (Mycoplasma, Chlamydia, human herpes virus-6) in blood of chronic fatigue syndrome patients: association with signs and symptoms. By G. L. Nicolson et al., Acta Pathol. Microbiol. Immunol. Scand.(APMIS) 2003; 111: 557-566. pdf doc

Immunophenotyping predictive of mycoplasma infection in patients with chronic fatigue Syndrome. By J. Nijs et al., J. Chronic Fatigue Syndr. 2003; 11(2): 51-70. rtf doc

Evidence for Bacterial (Mycoplasma, Chlamydia) and Viral (HHV-6) Co-Infections in Chronic Fatigue Syndrome Patients by G.L. Nicolson et al., Journal of Chronic Fatigue Syndrome 2003; 11(2):7-20. rtf doc

High Prevalence of Mycoplasma infections among European Chronic Fatigue Syndrome patients. By J. Nijs et al., FEMS Immunol. Med. Microbiol. 2002; 34:209-214. rtf doc

Bacterial and Viral Co-Infections in Chronic Fatigue Syndrome (CFS/ME) Patients, by Nicolson et al., Proc. Clinical & Scientific Conference on Myalgic Encephalopathy/Chronic Fatigue Syndrome, the Practitioners Challenge, Alison Hunter Foundation, Sydney, Australia 2002. rtf doc

Review: Immunology of Chronic Fatigue Syndrome by R. Patarca et al. J. Chronic Fatigue Syndr. 2000; 6(3/4): 69-107. rtf doc

Examination of mycoplasmas in blood of 565 Chronic Illness patients by polymerase chain reaction. by M. Nasralla, J. Haier, N. Nicolson and G.L. Nicolson, Intern. J. Med. Biol. Environ. 2000; 28(1): 15-23. rtf doc

Diagnosis and integrative treatment of intracellular bacterial infections in Chronic Fatigue and Fibromyalgia Syndromes, Gulf War Illness, Rheumatoid Arthritis and other chronic illnesses. by G.L. Nicolson et al., Clin. Pract. Alt. Medicine 2000; 1(2): 92-102 rtf doc

Role of Mycoplasmal Infections in Fatigue Illnesses: Chronic Fatigue and Fibromyalgia Syndromes, Gulf War Illness and Rheumatoid Arthritis, by G.L. Nicolson et al., J. Chronic Fatigue Syndr. 2000; 6(3/4):23-39 rtf doc

Identification And Treatment Of Chronic Infections In CFIDS, Fibromyalgia Syndrome And Rheumatoid Arthritis, by G.L. Nicolson, CFIDS Chronicle 1999; 12(3): 19-21 rtf doc

Multiple Mycoplasmal Infections Detected in Blood of Chronic Fatigue Syndrome and Fibromyalgia Syndrome Patients, Eur. J. Clin. Microbiol. Infect. Dis. 1999 ; 18 : 859-865 rtf doc

Mycoplasmal Infections in Chronic Illnesses: Fibromyalgia and Chronic Fatigue Syndromes, Gulf War Illness, HIV-AIDS and Rheumatoid Arthritis, by G.L. Nicolson et al., Med. Sentinel 1999; 4: 172-176 rtf doc

The Pathogenesis and Treatment of Mycoplasmal Infections, by G.L. Nicolson et al., Antimicrob. Infect. Dis. Newsl. 1999; 17(11) : 81-88 rtf doc

Diagnosis and Treatment of Chronic Mycoplasmal Infections in Fibromyalgia and Chronic Fatigue Syndromes: Relationship to Gulf War Illness, by G.L. Nicolson et al., Biomed. Therapy 1998; 16: 266-271 rtf doc

Diagnosis and Treatment of Chronic Infections in Chronic Fatigue Syndrome, Fibromyalgia Syndrome and Gulf War Illness, by G.L. Nicolson and N.L. Nicolson, International Journal of Occupational Medicine, Immunology and Toxicology 1996 ; 5 : 69-78 rtf doc

*PDF files can be opened by obtaining a free copy of Adobe Acrobat from:
http://www.adobe.com/products/acrobat/readstep2.html



Reports

Finally an answer to the most common medical complaintFatigue, by Garth L. Nicolson Explore 10(1): 18-21 (2010). pdf doc

Dietary supplement Healthy Curb for reducing weight, girth, body mass, appetite and fatigue while improving blood lipid values with NTFactor Lipid Replacement Therapy- by Garth L. Nicolson, Rita Ellithorpe, and Robert Settineri. J. IiME 2009; 3(1): 39-48. pdf doc

Co-Infections in Fibromyalgia Syndrome, Chronic Fatigue Syndrome and Other Chronic Illnesses by Prof. Garth Nicolson, Fibromyalgia Frontiers 2002; 10(3):5-9, 27-28. rtf doc

Update on Gulf War Illnesses: Relationship to Fibromyalgia Syndrome, Chronic Fatigue Syndrome/M.E. and the Possible Role of Vaccines By Prof. Garth Nicolson, The Fibromyalgia Survivor, 2001 rtf doc

Mycoplasmas: the Missing Link in Fatiguing Illnesses by Michael Guthrie Alternative Medicine; 2001; Sept: 60-70. rtf doc

Research Overview: Professor Garth Nicolson's Studies and Treatments Explained By Deborah Cooper, ImmuneSupport.com Treatment & Research Library rtf doc

CFS National Radio Program 11/21/00 with Dr. Roger G. Mazlen interviewing Prof. Garth Nicolson rtf doc

Chronic Infections in Fibromyalgia Syndrome: Sources of Morbidity and Illness Progression. by Prof. Garth Nicolson, Fibromyalgia Survivor 2000 rtf doc

New Treatments for Chronic Infections Found in Fibromyalgia Syndrome, Chronic Fatigue Syndrome, Rheumatoid Arthritis and Gulf War Illnesses, by Prof. Garth Nicolson, Kuwait University Faculty of Science and Medicine Newsletter, 1999 rtf doc

The Role of Chronic Infections in the Maintenance and Progression of Chronic Fatigue Syndrome, Fibromyalgia Syndrome, Rheumatoid Arthritis, Immune Deficiency Syndromes and Gulf War Illness, by G.L. Nicolson et al., ME/CFS Congress, Sydney, Australia, 1999 rtf doc

Identification and Treatment of Chronic Infections in CFIDS, Fibromyalgia Sydrome and Rheumatoid Arthritis Patients that Cause Morbidity and Illness Progression, by Prof. Garth Nicolson, Doctor's Educational Booklet, CFIDS Assoc. of America, 1998 rtf doc

Mycoplasmal Infections in Blood from Patients with Chronic Fatigue Syndrome, Fibromyalgia Syndrome or Gulf War Illness, by G.L. Nicolson et al., International CFS Congress, Sydney, Australia, 1998 rtf doc

New Treatments for Chronic Infections Found in CFS, Fibromyalgia Syndrome and Gulf War Illnesses, by Prof. Garth Nicolson, American Academy of Environmental Medicine Newsletter (Winter 1997) rtf doc

*PDF files can be opened by obtaining a free copy of Adobe Acrobat from:
http://www.adobe.com/products/acrobat/readstep2.html

Thanks CBS for yet more valuable info. I did not understand what the term "non-systemic" meant and how important that was. Thanks for that. Thanks also for the info on motility and autonomic dysfunction (part of CFIDS I believe and a very big issue with me). You are great at pulling pieces together. We all are just so sick with this thing that my friend's husband brings to work pants and underpants and I have insisted that my BIL wear Depends (works, don't laugh)g. BUT, this issue needs medical treatment and you may be on to a better med than what my GI doctor thinks she's going to be putting me on but isn't going to (cortisone med, not happening).

FWIW, I've needed three courses of Xifaxan in the last 8 months. Each time, 90% of the symptoms were gone in 5 days. When this starts (and before I can fill the Rx) Gas-x helps deal with the bloating and gas. And yes, the non-systemic part is huge, especially if you'll be needing to retreat occasionally. Untreated SIBO can also increase risk for other infections. It changes the permeability of the gut and last summer I landed in the Heart/Lung unit (the choice was that or the intensive care unit) of our regional medical center for four days. I had developed sepsis from a campylobacter infection that was probably made more likely by the SIBO (campylonbacter is not treated with Xifaxan - it is treated with a systemic antibiotic such as Flagyl). It scared the hell out of my PCP and my GI. The ER doc made sure to tell my wife that the sepsis had required "life saving measures."

I have been on doxcycline for a couple of weeks for an eye infection and have found it has helped with diarrhoea etc, have also had success with flagyl as well. Found this article which may be of interest, http://www.healthsystem.virginia.edu/internet/digestive-health/nutritionarticles/zaidelarticle.pdf

Thanks CBS I would very much so be interested in some current literature. This SIBO sounds very interesting. Thanks so much for your reply

Thanks also Acer I will google Dr DeMeirler today. Im not too sure what the GI expert thought was killed off exactly. I know they found one named parasite in my bowel called Dientamoeba fragilis and two others that were unamed. I thought he was referring to these perhaps. The problem with my bowel is that I have very little good bugs - my specialist said my tests were in the top 10 worst cases she'd ever seen. So they are worried to hit me with the antibiotics becuase it kills off my good as well as bad.

Ive taken extremely expensive probiotics in the past that do me no good at all - for some reason I seem worse on them. Odd too becuase my Mum ( a serious CFS for over 25yrs also gets a lot sicker on them too. I have no idea why this is.

Thanks Karin - those books you recommended are great! Im still puzzled though as to why the Flagyl aftereffects only lasted me 3days. I would have thought after 10days I would have at least got more a of rush from it?

Muffin your info was really helpful thank you

You guys are great - thanks for giving me some new direction here

thanks heapsreal - i'll check that website out

CBS: Your trip to the heart/lung unit freaked me out! You were horribly sick. This stuff is far more dangerous than what I had realized. I'm glad you made it out alive and that you posted this tale here so that I and others can read just how deadly things can turn with the gut. I guess it is time for me to be more proactive about my GI issues than what I have been. Though I have lived with this stuff all my life going back to nursery school, it did get horribly worse once I got CFIDS and now it's some sort of see-saw with the "overworking/not working" thing going on. I had better deal with the infection that the GI doc thinks is going on in the colon and not ignore it as I had planned on doing. You know, it gets soooo old going to these darn doctors that I just only go when things have reached critical and not before.

Thanks and very glad you got out alive.

Hi Tembo -- just a guess here, but perhaps the probiotics were doing battle with the bad bugs (causing them to release toxins as they're killed off) and/or improving your immune response, hence the reason for feeling worse? I think that's to be expected in many cases, until the good and the bad are balanced.

I had the same parasite about five years ago...can't remember the antibiotic combo that was used (I can try to find it in my files) but do remember that one of them had to be compounded at a pharmacy...was kind of surprised that my doc at the time agreed to go for it.

Muffin -- thanks for your take on mycoplasma infections. I had a Metametrix gut test which found mycoplasma and streptomyces infections. Doc isn't going with antibiotics this time, but a homeopathic for mycoplasma, plus an enzyme that digests the biofilm, and Beta Glucan (which I just forgot to take!) to improve immune response and add good probiotics.

One last thing on probiotics -- some folks and some docs recommend both rotating different strains, and taking high-dose probiotics -- at least 10-15 billion, if not a lot more, each day.

just my two cents.

d.

SIBO Articles

I have these and others in PDF format. Not sure of the best way to share them for those that are interested. Send me a PM if you want more info.or a copy of the pdf.

Small intestinal bacterial overgrowth
REVIEW ARTICLE
S. V. RANA1 & S. B. BHARDWAJScandinavian Journal of Gastroenterology, 2008; 43: 10301037
Abstract
Small intestinal bacterial overgrowth (SIBO) syndrome is characterized in its florid form by diarrhoea and weight loss. The most common underlying factors are dysmotility, small intestinal obstruction, blind or afferent loops. Small intestinal bacterial overgrowth can be diagnosed by: 1) culture of jejunum aspirate for bacterial counts, 2) 14C-D-xylose breath testing, 3) non-invasive hydrogen breath testing using glucose or lactulose or 4) 14C-glycocholic acid breath testing. The treatment usually consists of the eradication of bacterial overgrowth with repeated course of antimicrobials, correction of associated nutritional deficiencies and, when possible, correction of the underlying predisposing conditions.


Breath test for differential diagnosis between small intestinal bacterial overgrowth and irritable bowel disease: An observation on non-absorbable antibiotics
I Esposito, A de Leone, G Di Gregorio, S Giaquinto, L de Magistris, A Ferrieri, G Riegler
World J Gastroenterol 2007 December 7; 13(45): 6016-6021

Abstract
AIM: To estimate the prevalence of small intestine bacterial overgrowth (SIBO) among patients with an earlier diagnosis of irritable bowel disease (IBS) in our geographical area, and to collect information on the use of locally acting non-absorbable antibiotics in the management of SIBO.
METHODS: A non-interventional study was conducted in 73 consecutive patients with a symptom-based diagnosis.
RESULTS: When the patients underwent a breath test, 33 (45.2%) showed the presence of a SIBO. After treatment with rifaximin 1200 mg/d for seven days in 32 patients, 19 (59.4%) showed a negative breath test one week later as well as a significant reduction of symptoms, thus confirming the relationship between SIBO and many of the symptoms claimed by patients. In the other 13 patients, breath test remained positive, and a further cycle of treatment with ciprofloxacin 500 mg/d was given for 7 additional days, resulting in a negative breath test in one patient only.
CONCLUSION: (1) about half of the patients with a symptomatic diagnosis of IBS have actually SIBO, which is responsible for most of the symptoms attributed to IBS; (2) only a breath test with lactulose (or with glucose in subjects with an intolerance to lactose) can provide a differential diagnosis between IBS and SIBO, with almost identical symptoms; and (3) the use of non-absorbable antibiotics may be useful to reduce the degree of SIBO and related symptoms; it must be accompanied, however, by the correction of the wrong alimentary habits underlying SIBO.

Antibiotic therapy in small intestinal bacterial overgrowth: rifaximin versus metronidazole
E.C. LAURITANO, et al.
European Review for Medical and Pharmacological Sciences 2009; 13: 111-116

Abstract. Background and Objectives: Few controlled trials on antibiotic therapy for small intestinal bacterial overgrowth are available at present. Aim of the study was to assess efficacy, safety and tolerability of rifaximin with respect to metronidazole for the treatment of small intestinal bacterial overgrowth. Material and Methods: We enrolled 142 consecutive patients with diagnosis of small intestinal bacterial overgrowth. Diagnosis of small intestinal bacterial overgrowth based on the clinical history and the positivity of glucose breath test. Patients were randomised to two 7-day treatment groups: rifaximin 1200 mg/day and metronidazole 750 mg/day. Glucose breath test was reassessed 1 month after. Compliance and side-effect incidence were also evaluated. Results: One drop-out was observed in rifaximin group. Five drops-out occurred in metronidazole group. The glucose breath test normalization rate was significantly higher in the rifaximin with respect to the metronidazole group (63.4% versus 43.7%; p<0.05; OR 1.50, 95% CI 1.14-4.38). The overall prevalence of adverse events was significantly lower in rifaximin with
respect to metronidazole group. Discussion: Rifaximin showed an higher SIBO decontamination rate than metronidazole at the tested doses, both with a significant gain in terms of tolerability. Either the present study or recent evidencies suggest that rifaximin represents a good choice for the management of patients affected by SIBO.

Small Intestinal Bacterial Overgrowth: A Framework for Understanding Irritable Bowel Syndrome
CLINICAL REVIEW
Henry C. Lin, MD
JAMA. 2004;292(7):852-858

Context Irritable bowel syndrome (IBS), which affects 11% to 14% of the population, is a puzzling condition with multiple models of pathophysiology including altered motility, visceral hypersensitivity, abnormal brain-gut interaction, autonomic dysfunction, and immune activation. Although no conceptual framework accounts for all the symptoms and observations in IBS, a unifying explanation may exist since 92% of these patients share the symptom of bloating regardless of their predominant complaint.
Evidence Acquisition Ovid MEDLINE was searched through May 2004 for relevant English-language articles beginning with those related to bloating, gas, and IBS. Bibliographies of pertinent articles and books were also scanned for additional suitable citations.
Evidence Synthesis The possibility that small intestinal bacterial overgrowth (SIBO) may explain bloating in IBS is supported by greater total hydrogen excretion after lactulose ingestion, a correlation between the pattern of bowel movement and the type of excreted gas, a prevalence of abnormal lactulose breath test in 84% of IBS patients, and a 75% improvement of IBS symptoms after eradication of SIBO. Altered gastrointestinal motility and sensation, changed activity of the central nervous system, and increased sympathetic drive and immune activation may be understood as consequences of the host response to SIBO.
Conclusions The gastrointestinal and immune effects of SIBO provide a possible unifying framework for understanding frequent observations in IBS, including postprandial bloating and distension, altered motility, visceral hypersensitivity, abnormal braingut interaction, autonomic dysfunction, and immune activation.




Small intestine bacterial overgrowth and irritable bowel syndrome-related symptoms: Experience with Rifaximin
Sergio Peralta, Claudia Cottone, Tiziana Doveri, Piero Luigi Almasio, Antonio Craxi
World J Gastroenterol 2009 June 7; 15(21): 2628-2631

AIM: To estimate the prevalence of small intestinal bacterial overgrowth (SIBO) in our geographical area (Western Sicily, Italy) by means of an observational study, and to gather information on the use of locally active, non-absorbable antibiotics for treatment of SIBO.
METHODS: Our survey included 115 patients fulfilling the Rome Ⅱ criteria for diagnosis of irritable bowel syndrome (IBS); a total of 97 patients accepted to perform a breath test with lactulose (BTLact), and those who had a positive test, received Rifaximin (Normix, Alfa Wassermann) 1200 mg/d for 7 d; 3 wk after the end of treatment, the BTLact was repeated.
RESULTS: Based on the BTLact results, SIBO was present in about 56% of IBS patients, and it was responsible for some IBS-related symptoms, such as abdominal bloating and discomfort, and diarrhoea. 1-wk treatment with Rifaximin turned the BTLact to negative in about 50% of patients and significantly reduced the symptoms, especially in those patients with an alternated constipation/diarrhoea-variant IBS.
CONCLUSION: SIBO should be always suspected in patients with IBS, and a differential diagnosis is done by means of a breath test. Rifaximin may represent a valid approach to the treatment of SIBO.

Thank you CBS for these excellent articles. How interesting and fascinating!!!

Check, check, and check! Applies 100% to me my kids.