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SIBO treatment with Xifaxan


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#1 CloudStrife

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Posted 24 March 2010 - 12:04 AM

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Hi,I just picked up my Rx of Xifaxan. I had the breath test last week after having IBS symptoms for 3 years that worsened over time. My colonoscopy revealed diverticula. Last year I had a suspected diverticulitis attack (maybe mild) and an anal fissure. I've tried all the OTC remedies I heard of for IBS: antispasmodics, peppermint oil, various fiber supplements, ginger, probiotics, daily yogurt intake.I had half of the Rx filled after sadly learning that the standard treatment of 1200 mg/day would cost twice what I had researched it to be online($200).Some things that I am wondering as I hold the first pill:- I took metronidazole last year for possible diverticulitis. Does the fact that it didn't cure my SIBO/IBS, lower the possibility that Xiffy will do the trick?- What have people found is the best way to supplement the diet when taking this, in order to insure proper gut bacteria? Probiotics? Yogurt? I'm nervous that these items may bring back the bacteria in the small intestine, since I've eaten yogurt daily for several months and it seems to have had no effect in the long term, maybe even a slight worsening. I'm nervous that I may have small bowel diverticula.- Are there any special approaches you'd recommend for my situation? Pi-IBS-C, anal fissure, diverticulosis. SOmetimes I think my C only exists because of diverticula-related cramps, otherwise I might have D.- Is the full treatment duration of 1200 mg for 10 days really needed? Isn't 7 days of antibiotic plenty?OK, here we go...


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#2 faze action

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Posted 24 March 2010 - 06:13 AM

Hi there.I do not know much about diverticulitis, but it can predispose one to SIBO. I suffer from SIBO myself and this was ruled out on colonoscopy and CT scan. Anyway I have taken rifaximin twice in the last year for the SIBO and both times it worked, but my symptoms returned after a few months. The fist time I took it was for 7-8 days... second time for the full 10 days (at the same dose you are on). So, I think 7 days could work, but I feel it's better to go with the full course as the bacteria may not be sufficiently "wiped out" and could overgrow again. Generally, with the SIBO, the underlying cause should be addressed since the bacteria are likely to overgrow again no matter what (in my personal experience anyway).The second time I took rifaximin I followed it with Align probiotic for about 8 weeks to help the good flora recover. One of the reasons that the yogurt may have made you feel worse (I had this happen as well) is because the pro-Bs in the yogurt are "combatting" the SIBO to some extent and this can cause bloating, discomfort, etc. I noticed this when I was on the antibiotic as well...however I am IBS-D (not C).I have never taken metronidazole, so I can't comment on that.

#3 CloudStrife

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Posted 25 March 2010 - 07:53 PM

Thanks. I'll let you know how it goes.Yesterday was the first day. Overall, I felt pretty good and my flatulence seemed to decline suddenly. Today, I had a bit more gas and bloating. I think I made the wrong choice for lunch today -- and also ate too much. I should probably wait to eat aggressively until after the treatment.Is there any new findings on what can cause SIBO to recur? My symptoms developed post GI infection, so I'm certain that has something to do with it.I just hope they figure it out in a couple years. Antibiotics are not a good thing to take repeatedly.

#4 Kathleen M.

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Posted 25 March 2010 - 09:09 PM

Sometimes you may need more than 7 days of a given antibiotic. Depends on the antibiotic and what they are using it for, and may depend on your symptom history and what the doctor finds tends to work for patients like you.Usually the main issues with antibiotics is stopping too soon, not taking too long.I think usually the relapse is because whatever caused it the first time isn't fixed by the antibiotics, it just clears out the bacteria.
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#5 faze action

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Posted 26 March 2010 - 08:53 AM

Is there any new findings on what can cause SIBO to recur?

Unfortunately, no. At least not that I've been able to find anywhere... the latest article about SIBO recurrence that I've read was dated a couple of years ago and they actually state in the first paragraph, "No data concerning SIBO recurrence are available."Here's the link, but you may need a login for the site:http://www.medscape....warticle/579303Basically, though, what causes it to recur is whatever caused it in the first place (so you need to determine that at least). I think with post infectious SIBO I've heard that a percentage of people get recurrences for a few years or so and then it just stops (I read that somewhere, might have been on this board).

#6 CloudStrife

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Posted 27 March 2010 - 03:50 PM

Basically, though, what causes it to recur is whatever caused it in the first place (so you need to determine that at least). I think with post infectious SIBO I've heard that a percentage of people get recurrences for a few years or so and then it just stops (I read that somewhere, might have been on this board).

I assume that's if it gets treated after each occurrence.On another note, I'm actually feeling rather sick, like bad cold sick, for the past 2 days. Maybe a virus has taken over my innards. And, I'm having quite a bit of gas. Maybe I have a resistant bacteria. The last time I had an antibiotic, I was practically gas free.

#7 CloudStrife

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Posted 09 April 2010 - 10:06 PM

Well, I was feeling so bad that I stopped the drug treatment after 5 days. I was having cramps and an unusual smell.The good news is that in the next few days I started feeling better. Right now I probably have somewhere between 30-50% less gas than I had a couple months ago. which is still more than the amount I had ages ago, but it's a big help.Unfortunately, I have some anal discomfort, a persistent issue after the fissure I had. I think it's a skin pile.Since I was feeling odd while on the antibiotic, I decided to follow it with a careful regimen of probiotics. I'm taking Align every other day, alternated with a half cup of yogurt. I'm taking either in the morning, half an hour before eating anything. I think this may be wise for SIBO sufferers. It seems like a good idea to keep food and probiotics separate so the bacteria don't eat the food that you digest and multiply in the small intestine.

#8 njrunner

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Posted 13 June 2010 - 03:19 PM

I'd like to chime in here.I'm on my second round of xifaxan in three months. I was diagnosed w/SIBO in early March, took the antibiotic, but the problem never fully resolved itself. The symptoms (gas & bloating) resurfaced in early June. I'm back on the antibiotic (day 4 now). The only time I feel human/normal is when I'm on the medication. It makes me feel better knowing the diagnosis is most likely correct, but I'm worried the problem is going to return again.Has anyone had any success getting rid of SIBO permanently? If so, what worked (diet, meds, etc...)?Thanks.

#9 opticalcy

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Posted 27 June 2010 - 11:01 AM

I'd like to chime in here.I'm on my second round of xifaxan in three months. I was diagnosed w/SIBO in early March, took the antibiotic, but the problem never fully resolved itself. The symptoms (gas & bloating) resurfaced in early June. I'm back on the antibiotic (day 4 now). The only time I feel human/normal is when I'm on the medication. It makes me feel better knowing the diagnosis is most likely correct, but I'm worried the problem is going to return again.Has anyone had any success getting rid of SIBO permanently? If so, what worked (diet, meds, etc...)?Thanks.

I'm taking metronidazole 500mg three times a day for 7 days to treat possible SIBO. I didn't get the test, because I live in Canada, family doctors can't order these tests here. in fact, most family docs never even heard of it here...so I convinced my doc to do an empirical...I'm on day 3, so far the first two days I felt alot better and the symptoms are not 100% gone but I'd say improved by at least 70%, my bowel movements were never formed like this though it's still not the normal perfect type, but I'm only on day 3...the problem now is that I figure this probably means I possibly have SIBO but it's ganna return some time in the short future(cuz I havent treated it with any meds in the past 4 years)...and when they return I'm afraid the metronidazole won't be effective as this time. Rifiximan isn't even available here in canada...so the outlook is very bleak...anyone had experiences of treating SIBO with Metronidazole?

#10 Kathleen M.

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Posted 27 June 2010 - 11:21 AM

Before Rifiximan was ever on the market anywhere metronidazole and other antibiotics were used to treat "Classic SIBO".http://www.medicinenet.com/small_intestinal_bacterial_overgrowth/page6.htmIBS-SIBO should respond to all the same antibiotics.
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#11 opticalcy

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Posted 27 June 2010 - 11:32 PM

Before Rifiximan was ever on the market anywhere metronidazole and other antibiotics were used to treat "Classic SIBO".http://www.medicinenet.com/small_intestinal_bacterial_overgrowth/page6.htmIBS-SIBO should respond to all the same antibiotics.

Thank you for the information...I want to respond to the last thing you mentioned, two weeks before starting this round of metronidazole high dose, I was on the prevpac for possible H.Pylori(tested negative but convinced doc to do empirical), the two antibiotics amoxicilin and clarithromycine not only DIDN'T help but also worsened my diarrhea problem Immediately after I take the meds in the morning...I had to stop at day 9 out of total 14 days my doc prescripted...anyways, I'm ganna finish metronidazole cuz it's working...but if they return, I don't know how I'm ganna get xifixan...here is another study that's really interesting and couraging...I also suffer from skin problems I believe is linked to my SIBO condition:http://www.rosaceagroup.org/The_Rosacea_Forum/showthread.php?t=21036

#12 Kathleen M.

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Posted 28 June 2010 - 06:18 AM

Different antibiotics kill different things so not all of them are going to work for SIBO, but some are more known for killing off the types of bacteria in the gut flora than others.Antibiotics also can have direct side effects, so you always have to balance what you tolerate with what kills the bacteria.Some of the antibiotics, especially erythromycin, speed up the transit through the gut in addition to other activity and low dose erythromycin (lower than what they usually use to kill bacteria) is sometimes used for those that need the gut to speed up. Sometimes it is used to extend remission of SIBO because it speeds things up enough it makes it harder for the bacteria to get re-established in the small intestine.
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#13 opticalcy

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Posted 29 June 2010 - 06:24 PM

Different antibiotics kill different things so not all of them are going to work for SIBO, but some are more known for killing off the types of bacteria in the gut flora than others.Antibiotics also can have direct side effects, so you always have to balance what you tolerate with what kills the bacteria.Some of the antibiotics, especially erythromycin, speed up the transit through the gut in addition to other activity and low dose erythromycin (lower than what they usually use to kill bacteria) is sometimes used for those that need the gut to speed up. Sometimes it is used to extend remission of SIBO because it speeds things up enough it makes it harder for the bacteria to get re-established in the small intestine.

This's really educational thanks so much...Do you think that SIBO is causing me to have a malabsorption condition since I havn't treated this diarrhea problem since it first occurred about 4, 5 years ago...and now(before taking the metronidazole) my symptoms(aside from all typical gut symptoms) are mainly fatigue, I'm just tired all day even without doing anything and especially in the morning waking up is like meeting satin for me..., muscle twitching(which i believe is also due to malabsorption of minerals or vitamins), low grade inflammation of the eyes and skin problems, my facial skin had developed this dry oily and somewhat flaky ichy with few boils and folliculitis(around the mouth) type of condition resembles seborrheic dermatitis and rosacea symptoms...I think it's due to the malabsorption of Vitamin Bs in the small intestines for a prolonged period of time...something interesting I noticed is that while I'm on the 5th day of metronidazole 500 TID, I have two boils developed on my face and several small folliculitis around the mouth I havn't had boils since I started taking florastor about 2 weeks before I started metronidazole 5 days ago...now they're not hurting anymore, but I mean shouldn't these problems be much milder or gone while I'm on the high dose of metronidazole? And if after I finish this course of metronidazole, they return should I take another course or should I take rifaximin? I know you're not a doctor but I'm just open to all sorts of ideas and discussions since my family doc is no better than you "experts" here on this...but I'm still glad he agreed to prescribe me metronidazole as empirical...

#14 Kathleen M.

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Posted 30 June 2010 - 07:56 AM

SIBO can effect absorption and someone had posted something about Rosacea, so it may be effecting other things.Not sure about the boils.Most of this will be a wait and see what clears up. Sometimes things in a person are unrelated, but sometimes they aren't and it can be hard to know ahead of time how related.Sometimes it is an indirect connection. You have two or more things going on and when one flares up the physical stress of that sets other things off.I would see how things are for a couple of weeks once you are off one medication to see if that settled the SIBO down.
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#15 BRAD B

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Posted 11 July 2010 - 03:51 PM

Im taking xifaxan now for about 6 days. Of course like most on here we have to be our own doctors. I have not been tested for SIBO but I think this is the direction I am heading next. I got my GI to perscribe me a two week course. So far not that great a result. Maybe a little better. I actually have crohns that is under control but have bad IBS D with urgency. I have had surgery and my ileocecal valve area was removed many years ago. Anyway by coincidence I had to take the antibiotic cipro a while ago and to my amazement my bowels became almost normal. Im talking NORMAL! I would go to the rest room for a day and would have no urgency but unfortunatly once I stopped it my symptoms slowly came back.Has anyone else had any experience with Cipro for SIBO and or repeated use of it. Brad

#16 nachos

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Posted 11 July 2010 - 07:18 PM

Im taking xifaxan now for about 6 days. Of course like most on here we have to be our own doctors. I have not been tested for SIBO but I think this is the direction I am heading next. I got my GI to perscribe me a two week course. So far not that great a result. Maybe a little better. I actually have crohns that is under control but have bad IBS D with urgency. I have had surgery and my ileocecal valve area was removed many years ago. Anyway by coincidence I had to take the antibiotic cipro a while ago and to my amazement my bowels became almost normal. Im talking NORMAL! I would go to the rest room for a day and would have no urgency but unfortunatly once I stopped it my symptoms slowly came back.Has anyone else had any experience with Cipro for SIBO and or repeated use of it. Brad

Hi Brad a few years ago after an antibiotc amoxicillan I actually had an overgrowth and was given cipro not for the overgrowth because my doctor did not know what was wrong with me and could not get a referral to a gi doctor but I had a 5 day curse of cipro after the first day I was almost back to normal. After the medication was done I did have ibd symptons for months.

#17 CloudStrife

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Posted 12 July 2010 - 02:10 PM

It has been a few months since I wrote about this. As I said, the rifaximin did not help and I think I had the other kind of bacteria that it doesn't kill (aerobes I guess?). Since then I have modified my diet to avoid common gas producers as much as possible (wheat, lactose, fructose, and some other starches). I have also tried various natural bacterial remedies, and I think I am seeing some improvement. I'll post an update if I feel that I've gotten significantly better.

#18 dan44

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Posted 23 January 2011 - 02:12 PM

Hi guys, Everyone is wondering why the symptoms are coming back. There must be some reason behind it. There are a lot of theories and I have a couple of them in my mind. I think antibiotics are simply not helpful. If on a course on antibiotics and symptoms greatly improve then there is no question this is a bacterial problem but antibiotics can't correct it permanently. Why? I don't know but I can say maybe something there becomes permanently damaged and the gut can't recover 100%. I never met someone to say: "I cured my SIBO"... never! Maybe we are stuck with this disease for life.I met people who said they are willing to put themselves on IV nutrition in order to allow their gut to recover and not to feed bacteria in gut for a long period.. couple of weeks.In other countries they use bacteriophages in order to get rid of bacteria since they have no side effects and are very efficient but unfortunately phages are very specific and they are not available in US or Canada but available in Mexico though.I have heard a lot of theories why the SIBO can't reverse: impaired gut motility, low production of secretory IgA, intestinal nerve damage, damaged ileocecal valve, damaged intestinal mucosa, parasites etc. If someone get cured of SIBO please share.

#19 ara01

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Posted 16 March 2012 - 09:22 AM

I'm so glad I found this thread and hope it's the right place to put this (or that it might bump up to the top for anyone who might have more experience with this). Let me start at the beginning. Everything started with what seemed like an average cold. After about 3 weeks, I went to my primary doctor who was worried it might have turned into bronchitis (I have a history of this). He gave me a prescription for a Z-Pack which the pharmacy filled incorrectly (they gave me a much lower dose than was needed). As a result, my symptoms did not get better and when I returned, I had a sinus infection which was subsequently treated with a course of Avelox. My sinuses got better, but the medicine made me feel extremely nauseated. I had dinner one night with a drink and a half to celebrate my SIL's official return back to normal health after a very rough run with IBD. The next thing I know, I'm beyond nauseated and vomiting. I started to get stomach cramps, severe bloating, and nausea that didn't go away. I was also still running a fever from the upper respiratory problems. I went back into my doctor who didn't have much advice. He suggested that I see an ENT since that's where my symptoms started and take Tylenol for the fever and Dramamine for the nausea.I started to lose my appetite. Two separate ENT's put me on medication for silent reflux/GERD which never felt right to me. My stomach problems started to get worse and the pain and cramping low so I decided to try and see my OB/GYN. She found a bacterial infection which was treated with an antibiotic cream. She ran a sonogram and said that other than a small cyst on my ovary, everything seemed normal. When I followed up with her, the bacterial infection was gone, but it had been replaced with GI problems that were steadily getting worse.I started to realize the nausea was more appropriately the result of severe bloating. I felt like I was 7 months pregnant, and I started to track it. Anytime I ate anything (and sometimes without eating at all), my stomach would be distended 6". I couldn't fit into any of my pants and the pressure from even an elastic waistband was painful (I've seriously considered buying maternity pants). The bloating takes away my appetite because I feel so uncomfortable that the last thing I want to do is eat. My organs feel pushed together and at times, it can be hard to breathe when it gets really bad. Early on, I started developing stretch marks on my belly button which started bleeding.I have also had a low grade fever (100 and below although my normal body temp is about 96.8--yes, the reverse of normal)especially with any type of activity (i.e. doing the dishes, laundry, etc.--luckily, I work from home for at least the next couple of months). My bowel movements haven't been normal since the symptoms started (C dominant, although a fiber supplement helps a little). Other symptoms include chronic fatigue, low immunity (and a never-ending barrage of colds any time any one else gets sick). And through the past 6 months, I've lost about 15 pounds (which actually brings my weight closer to normal).When I first saw my GI doctor, he ran several tests--CAT scan, colonoscopy, etc. and everything came back negative except blood work which showed signs of an infection, but no clear indicators on what. He finally decided to try a course of Xifaxan and 3 days in, I was finally symptom free. Everything disappeared. I finished the course of antibiotics and it came back like clock work. After a second attempt at treatment, he ordered an at home breath test. When he called me with the lab results, he told me that I tested positive for SIBO. But here's my biggest question...I know from the research I've done that SIBO tends to reoccur. However, has anyone else had almost constant symptoms when not on antibiotics? The antibiotics take it away, but symptoms return within 24-48 hours after I stop taking them. The only thing that worked for longer than that was a combined course of Flagyl and Augmentin which lasted about 2 weeks before the symptoms came back. I'm getting worried that the only thing that seems to take away my symptoms is an almost constant (daily) regiment of antibiotics and am afraid that this might eventually make things worse. I've now been on 3 or 4 courses of Xifaxan separated by 1 course of Flagyl and Augmentin in the past 4 months.And my symptoms keep getting worse. I just finished the latest course of Xifaxan and my symptoms are back, 24 hours later. In addition, it seems that the bacterial levels are so out of control that I've been dealing with dyshidrotic eczema for the first time ever. It's on my hands and feet and has come and gone depending on the severity of my other symptoms. I finally went to see a dermatologist when it started spreading and was becoming unbearable. The second topical cream he gave me (a corticosteroid) seems to finally be helping with this, but I can't help feeling like this is a sign the SIBO is completely out of control.I have not done just the antibiotic therapy. I've also tried to change my diet--going through periods of strict modification in which I removed all sugar/carbsand trying a middle-ground that is easier to manage with no sugar/limited carbs. I've tried gluten free, wheat free, etc. I know that yeast is one of my worst trigger foods and that wheat can be difficult too (I can usually handle white bread, not wheat if I let myself be flexible with my diet--that's my one treat). I've also tried probiotics, yogurt, apple cider vinegar, peppermint, ginger, and fennel supplements, an increase in vitamins, fiber supplements, etc. But I guess at this point, I'm not sure where to go from here. Do I continue taking antibiotics to treat the symptoms, but are clearly not addressing the problem? Do I try to find a new doctor who actually has experience treating SIBO (my current doctor does not but he was the only one to not brush off my condition as being too stressed/anxious)? Is there something else that I need to do/can do that will help? Has anyone else been here...or have any ideas? Please help...

#20 eddieb

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Posted 16 March 2012 - 10:14 AM

My Gp prescribed Norfloxacin 400 mg on the 17/2/12 ( US 2/17/12), twice a day for seven days. I had read in a newspaper that SIBO was a little known problem and that most Gp's wouldn't know a thing about it.Just so with my Gp, he had never heard of it.I have suffered excessive bloating and violent flatulence for as long as I can remember. I am 66 yrs of age and for the first time in my life am not worried about embarrassing farts.After two days of taking Norofloxacin I could tell there was a difference. After completing the course I can now eat Brussel sprouts, Broccoli and Baked Beans., sans eruptions.I am seeing my Gp again on Monday and will ask for another weeks supply, as I feel it is required.Another thing that has improved is my breathing, before these pills I had trouble taking deep breaths, now I can deep breath normally.





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