Question about abx and SIBO

[outdamnspot]

My understanding is that certain antibiotics are prescribed for SIBO over others (Rifaxamin etc.). I mentioned in a post last week that my doctor prescribed me Clarithromycin for a sinus infection, which also seems like a good choice for gut issues, but I got scared off trying it after reading it can adversely affect cortisol levels. I went back and asked for Doxicycline instead because I'd read it's generally well-tolerated, and didn't want to push my luck by asking for anything exotic (they're not a CFS doctor).

My food tolerances get worse every week and I'm probably too unwell to get back to a doctor anytime soon; I'd also read a few people on here say Doxy actually reversed some of their odd sensitivities/intolerances, so I'm curious to try it. I was just wondering, as far as abx and the gut goes, is it a particularly bad choice? I can't find too much on its use in SIBO, but when I google it is listed as a possible treatment.

 

[JES]

I personally haven't had any improvement from macrolides or doxycycline. Doxycycline carries pretty much the same risk as macrolides like clarithromycin in that it's a broad spectrum antibiotics. It might kill some of the bad bacteria if you are lucky or it might not, depending on what kind of overgrowth you have. Meanwhile, it will almost certainly also wipe out a lot of good bacteria. Rifaximin is pretty much the only antibiotic that seems moderately effective against SIBO without wiping out good bacteria from the large intestine.

I have trialed some broad spectrum antibiotics and I didn't receive any permanent damage from them, but while I was on them I definitely felt that my immune system took a hit after around 3-4 weeks. Apart from that, side effects of doxycycline aren't typically a big problem unlike with fluoroquinolones. I reckon sensitivity to sunlight was the only thing that the doctor warned me about.

 

[outdamnspot]

I personally haven't had any improvement from macrolides or doxycycline. Doxycycline carries pretty much the same risk as macrolides like clarithromycin in that it's a broad spectrum antibiotics. It might kill some of the bad bacteria if you are lucky or it might not, depending on what kind of overgrowth you have. Meanwhile, it will almost certainly also wipe out a lot of good bacteria. Rifaximin is pretty much the only antibiotic that seems moderately effective against SIBO without wiping out good bacteria from the large intestine.

I have trialed some broad spectrum antibiotics and I didn't receive any permanent damage from them, but while I was on them I definitely felt that my immune system took a hit after around 3-4 weeks. Apart from that, side effects of doxycycline aren't typically a big problem unlike with fluoroquinolones. I reckon sensitivity to sunlight was the only thing that the doctor warned me about.

Thanks for your reply. If doxy is no worse than the others (besides Rifaxamin) then I'll give it a shot; I have been wondering whether my rapidly increasing intolerances are linked to a gut infection, so this seemed like a good opportunity to experiment. The downside is it's only a 7 day course.

On a side note, I rarely weigh myself but checked last night and I've probably lost about 15kg since last October which is somewhat worrying.

 

[bjl218]

Any reason (other than the cost) that you don't want to try Rifaximin? This is the primary antibiotic prescribed for SIBO.

 

[outdamnspot]

Any reason (other than the cost) that you don't want to try Rifaximin? This is the primary antibiotic prescribed for SIBO.

Because I went to a walk in clinic for a sinus infection, so Rifaxamin seemed like an exotic request. I've been too sick to get to a gastroenterologist.

 

[bjl218]

I see. Yes, that would have been a pretty exotic request for a walk in clinic. And probably for most traditional gastroenterologists as well unfortunately.

Because I went to a walk in clinic for a sinus infection, so Rifaxamin seemed like an exotic request. I've been too sick to get to a gastroenterologist.

 

[kangaSue]

SIBO can take cycling of antibiotics for 10 days every month for a year or more before you finally knock it out. I've read many instances though where using the combination of rifixamin and metronidazole (in just the one course) was needed to eradicate SIBO when either drug alone didn't improve symptoms.

I have also read it suggested that doing the one course of any of the main abx's for SIBO (amoxycillin, doxycycline, metronidazole or rifixamin) then following it up with low dose naltrexone can nip in the bud even when you don't initially feel much benefit from the abx course.

 

[ebethc]

Herbal treatments are as effective or more effective as Rifaxmin and WAY cheaper. The two herbal formulations in this study were from Metagenics.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4030608/
Conclusion:
SIBO is widely prevalent in a tertiary referral gastroenterology practice. Herbal therapies are at least as effective as rifaximin for resolution of SIBO by LBT. Herbals also appear to be as effective as triple antibiotic therapy for SIBO rescue therapy for rifaximin non-responders. Further, prospective studies are needed to validate these findings and explore additional alternative therapies in patients with refractory SIBO.