Rifaximin & Neomycin

[hb8847]

I am about to undertake a course of these antibiotics as recommended by my Doctor in an attempt to correct for SIBO.

The plan is to take these over the course of two weeks and then take an breath test to check whether anything remains in my upper intestine.

Meanwhile I'll be on a low Fodmap diet. After the breath test I think the aim is to try to repopulate the gut using pre and probiotics.

Doctor says this combo of medication works in about 80% of patients with SIBO and for the remainder a further 50% respond well to herbal antibiotics.

Does anyone have experience with this?

 

[pamojja]

Doctor says this combo of medication works in about 80% of patients with SIBO and for the remainder a further 50% respond well to herbal antibiotics.

Does anyone have experience with this?

No experience myself. But this blog-post does have more detailed information about SIBO treatments:

https://selfhacked.com/blog/sibo-causes-and-treatment/

Also note this comment:

September 3, 2017at 6:22 pm

I have suffered with SIBO and Candida problems for more years than I care to remember. Over the years I tried many very expensive remedies with varying degrees of success and lots of challenging side effects.
What seems to be more effective then anything I tried before, was one of the simplest and cheapest. Just Vitamin C to bowel tolerance level. Which means:-

Day one take a gram of Vit. C. Increase this by one gram every day until you have loose bowel motions. Cut back by one gram each day until your bowel habits return to what is normal for you. Continue with this dosage until your SIBO improves. As and when you choose to end this treatment gradually reduce your dosage by one gram each day. If you stop large doses of Vitamin C abruptly you will experience scurvy like symptoms.

Depending upon what is going on in your body you might be very surprised just how much Vitamin C your body can actually utilize. For some the bowel tolerance will be 4-8 grams. For others it might be as high as 15-20 grams. If your body appears to need a high dose you might consider Ascorbic Acid Powder preferable to all those large tablets. Hope this helps. I wish someone had told me it could be that easy 30 years ago.

In my case when I titrated to bowel-intolerance, it was even at 50g per day.

 

[hb8847]

No experience myself. But this blog-post does have more detailed information about SIBO treatments:

https://selfhacked.com/blog/sibo-causes-and-treatment/

Also note this comment:



In my case when I titrated to bowel-intolerance, it was even at 50g per day.

Thanks for the reply.

I have done the whole "Vit C to bowel tolerance" thing in the past. I found it OK fot symptoms but didn't really help with the gut dysbiosis unfortunately.

 

[junkcrap50]

How is the Vit. C to bowel tolerance supposed to help cure SIBO? Too acidic of an environment for bacterial colonization in the small intestines?

Also, is this daily dose of Vit. C in 1 large dose per day or several divided doses per day, adding up to your tolerance dose?

 

[pamojja]

How is the Vit. C to bowel tolerance supposed to help cure SIBO? Too acidic of an environment for bacterial colonization in the small intestines?

Since I never had SIBO I can only speculate. Acidity of vitamin C can't be the reason, because stomach is around 50 times stronger acid. Therefore I suspect it's mainly the flushing out with liquid stuhl, along with the many beneficial other functions of vitamin C, helping with SIBO. Since SIBO can develop secondary to other conditions (see the article linked to).

Also, is this daily dose of Vit. C in 1 large dose per day or several divided doses per day, adding up to your tolerance dose?

Titrating to bowel tolerance means maximizing intake of ascorbic acid in a day. For example my limit of 1 single dose, above which I get a liquid stuhl from ascorbic acid, is 10g already. If I take smaller doses frequently throughout the day, that limit is extented to above 50 g per day. The later is what is meant with bowel tolerance.

Bowel tolerance can be verry individual. In some its above 100 g/d. In a very few it could already be 1 g per day only. Therefore always start very low. And best use pure ascorbic acid powders, to avoid too many binders and fillers.

 

[hb8847]

How is the Vit. C to bowel tolerance supposed to help cure SIBO? Too acidic of an environment for bacterial colonization in the small intestines?

Also, is this daily dose of Vit. C in 1 large dose per day or several divided doses per day, adding up to your tolerance dose?

No as far as I'm aware it's nothing to do with this. The body absorbs the vitamin C into the blood (mostly from the stomach) which then helps immune system (mops up free radicals or something). Animals produce vitamin C in high doses when ill, humans are one of only 2 mammal species that don't.

Any excess is then excreted as diarrhoea, indicating the body has had its fill of vitamin C and doesn't need any more.

You need to do this each day afresh. At its worst my tolerance was upwards of 80g, came down to about 50 over a few months as my health improved but was very much as an adjunct to ease my symptoms of detoxing rather than the treatment itself.

 

[MichaelM]

I'm interested in this thread as I'm going to start Rifmaxin soonish for SIBO too. Posting to follow others responses.

I'm quite terrified of antibiotics for a few reasons, so keen to hear of others experiences. My condition is SIBO related and probably caused mostly by elevated d-lactate from the SIBO, which is causing neuro issues (so I am very cautious with altering gut as the neuro issues increase). Rifamaxin should be the right call though!

Anyone titrate/test with antibiotics first? I was thinking to start with 100mg or even less, before moving to 400mg gradually, to avoid sudden effects.

 

[ljimbo423]

I'm quite terrified of antibiotics for a few reasons, so keen to hear of others experiences. My condition is SIBO related and probably caused mostly by elevated d-lactate from the SIBO, which is causing neuro issues (so I am very cautious with altering gut as the neuro issues increase). Rifamaxin should be the right call though!

I took 2 courses of Rifaximin when I started treating dysbiosis. I couldn't tolerate even very low doses of herbs to treat dysbiosis.

So I decided to see if lowering the bacterial overgrowth in my gut with Rifaximin would lessen the effects of killing off pathogenic bacteria with herbs and it did. Enough so that I could start a good herbal protocol.

Anyone titrate/test with antibiotics first? I was thinking to start with 100mg or even less, before moving to 400mg gradually, to avoid sudden effects.

I started with just 100mg a day (I cut the pills in half), because I was worried about feeling like I got run over by a truck. BUT, I didn't have any side effects from Rifaximin, other than loose stool for a day. I slowly, over a few days moved up to 1,200 mg a day, no problem.

Rifaximin doesn't actually kill the bacteria. It stops them from multiplying, therefore lowering the bacterial overgrowth that way. When bacteria in the gut are killed, directly, like with herbs, it often causes what we call "die-off symptoms".

Which are basically a magnification of the symptoms someone has already. It also only works in the small intestine and becomes inactivated in the large intestine.

 

[MichaelM]

@ljimbo423 thanks so much, yes when I tried oregano oil for 4 days I had a large remission into chronic fatigue. I seem to get 2 main sets of acute symptoms, although they go together too. CF is one of them, neuro symptoms then can also exist without stronger fatigue.

Anyways, your post is reassuring. I was considering doing it the other way around and doing some oregano and allicin, but perhaps not (I had read Rifamaxin first was a better way to do it elsewhere too, but because it was stronger).

Also really interesting what you say about Rifamaxin not killing the bacteria. In reading the "side effects" on the obvious sites online, the list is pretty much on par with any other antibiotic. I was wondering why it's regarded as a safer option but was waiting to ask my gastro/ask people first.

Pretty much your exact protocol sounds like how I would do it, working up to 1200mg a day I think is the goal (for 2 weeks?).



Also FYI all, in the end my plan is to round it off with an FMT. But your approach @ljimbo423 is inspiring me to perhaps be more conservative and not rush into that. Make sure to really clear everything out longer term before introducing a new family


Also @hb8847 I liked reading this:

Doctor says this combo of medication works in about 80% of patients with SIBO and for the remainder a further 50% respond well to herbal antibiotics.

I had thought SIBO was more hit and miss than that. Also I had heard of neomycin but not considered it, perhaps it's something for me to consider as a 2nd course option later. Thanks

What type of breath test did you do and do you have bad CFS and/or neuro symptoms? Best wishes

 

[MichaelM]

RE Vit C, in some ways I wonder if just using fat soluble Vit C or other antioxidants do the same thing? That many grams of Vit C must mean you are constantly flushing it out? Just speculating here and sharing my experience.

It seems Vit C can work wonders though. I've heard flushing with sodium ascorbate massively diminishes opiate withdrawals.

Personally Vit C hasn't done much for my inflammation/SIBO alone (although I didn't try flushing beyond a few grams), but many antioxidants do help a great deal, especially fat soluble Vit C, Gamma-E, ALA and so on.

Maybe I should get my bag of sodium ascorbate out (even though it's 2+ years old) and try an 80g flush


EDIT: to avoid gastro distress sodium ascorbate is the way to go apparently, over the acid version. Except of course, the sodium content.... can always try to balance with potassium, or just go half half in different types maybe?

 

[ljimbo423]

Also really interesting what you say about Rifamaxin not killing the bacteria. In reading the "side effects" on the obvious sites online, the list is pretty much on par with any other antibiotic. I was wondering why it's regarded as a safer option but was waiting to ask my gastro/ask people first.

I can think of a couple reasons. First, it's not absorbed into the bloodstream, so it's not systemic. Second, it only works in the small intestine and doesn't effect the bacteria in the large intestine.

So if all you have is SIBO, that is all it will treat. Another reason I have heard also, is that it has to be used many times or long term for most people to develop bacterial resistance to it.

Also FYI all, in the end my plan is to round it off with an FMT. But your approach @ljimbo423 is inspiring me to perhaps be more conservative and not rush into that. Make sure to really clear everything out longer term before introducing a new family

So you want to move out the old tenants, before you move in the new ones?

 

[hb8847]

It also only works in the small intestine and becomes inactivated in the large intestine.

Interesting, you're referring to Rifaximin here? Do you know how this happens?

My understanding was that antibiotics were sort of like a nuclear weapon, annihilating everything in sight - both good and bad bacteria - and so I'd assumed it would affect the ones in my lower intestine too. Apparently it's less absorbed into the bloodstream though which is why it's good for gut related problems.

 

[hb8847]

Also @hb8847 I liked reading this:

I had thought SIBO was more hit and miss than that. Also I had heard of neomycin but not considered it, perhaps it's something for me to consider as a 2nd course option later. Thanks

What type of breath test did you do and do you have bad CFS and/or neuro symptoms? Best wishes

The specific advice to me is to take Rifaximin 550mg three times daily and Neomycin 500m twice daily for 2 weeks (ie both together).

I've had a few stool tests over the past few years which show the bacterial makeup of my gut as a whole. I haven't taken a breath test yet because I've had pretty severe food intolerances at times (it involves swallowing a sugar solution) and we've both agreed it's not worth it when I already have the stool results.

I have had CFS for maybe 3.5 years and cognitive/mental health issues for a further 7 or 8.

We've also determined a big cause of my issues is chronic undermethylation. This is crucial to - amongst other things - producing energy for the body and can occur from a lack of B12 and B9. I have been on high dose B vitamin supplements for a while now and have gotten significantly better, maybe around 60% overall.

SIBO can directly cause this - even if you're getting enough sources of vitamins from your food the bacteria in the small intestine take for themselves, deprives your body. Over time this can cause severe deficiencies and problems, and is my best guess as to what's happened to me.

The aim currently is to keep supplementing with the B vitamins and get my methylation and health up to a steady level, and then to attack the SIBO, probably within the next month or so.

 

[ljimbo423]

Interesting, you're referring to Rifaximin here? Do you know how this happens?

Yes, Rifaximin is unique, in that it needs bile to become activated and is less than 1% absorbed systemically.

Bile is dumped into the small intestine from the gallbladder, then about 95% of it is reabsorbed at the end of the small intestine before it can get into the colon or large intestine. The lack of bile in the large intestine deactivates Rifaximin.

Metabolism and Pharmacokinetics
The lack of absorption of rifaximin in the gastrointestinal tract enhances fecal concentrations of this drug and limits its systemic toxicity.

Studies with radio-labeled rifaximin have demonstrated less than 0.4% of detectable rifaximin in the blood and urine, undetectable levels in the bile and breast milk, and 97% recovered unchanged in the stool after oral ingestion (2) (4).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737517/

Solubility of the drug (Rifaximin) increases 100-fold in the presence of bile acids, which suggests that its antimicrobial effect is primarily achieved in the small bowel and less so in the colon.25

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4467648/

 

[ljimbo423]

@hb8847 - Here is the full prescribing info. pamphlet for Rifaximin if you are interested-
https://shared.salix.com/shared/pi/xifaxan550-pi.pdf

 

[MichaelM]

@ljimbo423

super interesting, glad I'm in this thread as I won't be seeing my gastro again for a month... his follow ups always feel like they are over in 30 seconds and before I've even asked my most important questions!

I have had CFS for maybe 3.5 years and cognitive/mental health issues for a further 7 or 8.

interesting, I've dealt with chronic anxiety and fatigue etc for over 5 years and this latest CFS-like/MS-like issue for 2 years ish. I'm pretty much on the same approach in that I have nearly exhausted all my other self care interventions and good nutrition etc, next it's kill the SIBO time and see what happens. Pretty much pinpointing my main issue to overgrowth of lactic acid bacteria and thus elevated d-lactate causing systemic/neuro issues. Will be testing for this soon but having to take a broad Genova urine test just to get the d-lacate result.

Yeah the sugar for the breath tests made me pretty unwell. I just got close to a moderate remission phase and then drank 70g of dextrose (after the lactulose a few days earlier). That sent me over the edge again, happy times.

Will be interested in your progress.

 

[hb8847]

@ljimbo423

super interesting, glad I'm in this thread as I won't be seeing my gastro again for a month... his follow ups always feel like they are over in 30 seconds and before I've even asked my most important questions!



interesting, I've dealt with chronic anxiety and fatigue etc for over 5 years and this latest CFS-like/MS-like issue for 2 years ish. I'm pretty much on the same approach in that I have nearly exhausted all my other self care interventions and good nutrition etc, next it's kill the SIBO time and see what happens. Pretty much pinpointing my main issue to overgrowth of lactic acid bacteria and thus elevated d-lactate causing systemic/neuro issues. Will be testing for this soon but having to take a broad Genova urine test just to get the d-lacate result.

Yeah the sugar for the breath tests made me pretty unwell. I just got close to a moderate remission phase and then drank 70g of dextrose (after the lactulose a few days earlier). That sent me over the edge again, happy times.

Will be interested in your progress.

Wow, thanks for the advice re the breath test. That's exactly what I'm worried about. Unfortunately I think it has to be done though to check whether I've gotten rid of the SIBO. But yeh like I said I am getting so much better on the B Vitamin supplements I don't think I'll be throwing anything else into the mix until I'm quite considerably better.

Interesting you seem to have had a similar pattern as me regarding symptoms and their onset. Some things I've learnt over time just in case they might be helpful to you:

- Given you have SIBO, neuro symptoms and chronic fatigue it might be worth checking out methylation as a potential issue. As I said in a previous post, SIBO can gobble up useful vitamins and seem particularly keen on B12 which is an essential nutrient for energy production and cognitive function. The effect it has had on me has been life changing. If you do decide to give it a go I'd recommend having a look at Ben Lynch's site and following his recommendations.

- Apparently the FODMAP foods are particularly bad for SIBO as they remain in the upper gut for longer than other fibres and provide food for the bacteria living there.

- Another factor related to both SIBO and methylation is histamine intolerance. You've mentioned anxiety and CFS which can both be symptoms of this, if you have certain foods which make your symptoms flare (often not immediately after eating) then histamine intolerance might be a factor.

Best of luck with your treatment.

 

[hb8847]

@hb8847 - Here is the full prescribing info. pamphlet for Rifaximin if you are interested-
https://shared.salix.com/shared/pi/xifaxan550-pi.pdf

Thank you for this.

Have you any experience of Neomycin by any chance?

 

[MichaelM]

Wow, thanks for the advice re the breath test. That's exactly what I'm worried about. Unfortunately I think it has to be done though to check whether I've gotten rid of the SIBO. But yeh like I said I am getting so much better on the B Vitamin supplements I don't think I'll be throwing anything else into the mix until I'm quite considerably better.

Interesting you seem to have had a similar pattern as me regarding symptoms and their onset. Some things I've learnt over time just in case they might be helpful to you:

- Given you have SIBO, neuro symptoms and chronic fatigue it might be worth checking out methylation as a potential issue. As I said in a previous post, SIBO can gobble up useful vitamins and seem particularly keen on B12 which is an essential nutrient for energy production and cognitive function. The effect it has had on me has been life changing. If you do decide to give it a go I'd recommend having a look at Ben Lynch's site and following his recommendations.

- Apparently the FODMAP foods are particularly bad for SIBO as they remain in the upper gut for longer than other fibres and provide food for the bacteria living there.

- Another factor related to both SIBO and methylation is histamine intolerance. You've mentioned anxiety and CFS which can both be symptoms of this, if you have certain foods which make your symptoms flare (often not immediately after eating) then histamine intolerance might be a factor.

Best of luck with your treatment.

I think after antibiotics you will probably have a whole lot less to worry about doing the breath test.

I was actually in a manageable phase for the first one and drinking the lactulose was OK, just a little bit of symptoms. It took me another 3 days of slightly bad eating then the 70g dextrose to make me unwell. Just listen to where your body is at to see if you can take the risk. I think if I had been properly unwell I would definitely have avoided both the tests. The 70g sugar was a little bit of a surprise though because the first day was not terrible, it was the next day that the change had taken place. It was certainly risky for me given that elevated d-lactate can cause real damage. But now I know my limits so that's quite helpful too. I have an antibiotic prescription on hand just in case and a ton of detox support in supplements.

I guess it depends on the specifics of your condition though too. You may find lactulose less tolerable than me, who knows.

Thanks for the other tips. I do get a fair intake of b vits and my energy is generally OK these days but will look a bit deeper.

Either way I will be doing this test for a load of things including d-lactate and methylation indicators, will be interesting to see what comes up:

https://www.gdx.net/uk/product/organix-comprehensive-profile-metabolic-function-test-urine


I had read about histamine in the past but it never quite chimed with me. I eat loads of avocados and spinach as part of my diet and I seem to do OK on them. The thing is the gut changes a lot and maybe in some phases I'm missing what exactly is going on. Even the pros don't really know...

 

[MichaelM]

I started with just 100mg a day (I cut the pills in half), because I was worried about feeling like I got run over by a truck. BUT, I didn't have any side effects from Rifaximin, other than loose stool for a day. I slowly, over a few days moved up to 1,200 mg a day, no problem.

I am looking at my Rifaximin pills and they are film coated. Only just googling now, but I'm assuming these shouldn't be split?

Thoughts?

Maybe I should just split one for an allergy test at the very least, which is my biggest concern. However I guess if they are film coated, something about them gets degraded in the stomach?