# SIBO Treatment



## sonic123 (Jul 5, 2012)

Positive breath test for SIBO. Doctor prescribed either Xifaxan 550 mg three times per day or Rifaximin 400 mg twice a day. This totals 1650 mg of Xifaxan or 800 mg Rifaximin daily. My experience is that generics usually come in the same dosages as brand names. But does anyone know why the discrepancy in dosages between brand name & generic. The obvious answer is that Rifaximin is twice as strong as Xifaxan. Can anyone confirm this. Also, doctor said that lactulose breath retest should be repeated within 4-21 days after finishing antibiotic. If antibiotic is supposed to correct the problem permanently, why the limitation of 21 days on the retest? Thanks.


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## Kathleen M. (Nov 16, 1999)

Usually the antibiotic is typically not a one and done permanent cure, and if it doesn't work (and sometimes you need a different antibiotic depending on what is in there) you really want to test at a time when you are most likely to know it worked, or didn't work.SIBO tends to come back after awhile, a few people are lucky, but I don't like anyone telling you one round of antibiotics and you should be cured forever, that doesn't seem to be the general rule, and seems like a way to set people up for a big disappointment 3-6 months down the road. Waiting many weeks or a few months before retesting doesn't help much in figuring out if the antibiotic didn't work and you need to try a different one, or need another course of it, especially if you get into the range where SIBO may be coming back.Not sure about the difference with what should be identical medications. I'll see if anything says why that would be.Couldn't find anything, you might ask the doctor what evidence he is using for the different dosages.


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## sonic123 (Jul 5, 2012)

Thanks, Kathleen. Your explanation makes sense on retesting. But I think the doctor's office made a mistake on the dosing. I checked & he corrected that it would be Xifaxan 200 mg 3x/day or Rifaximin 400 mg 2x/day, which makes more sense. Is there any evidence that Xifaxan works better than Rifaximin? And is there an correlation between breath test level and how many rounds of antibiotics necessary to eliminate SIBO permanently?


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## Kathleen M. (Nov 16, 1999)

No correlation that I know of with the # of rounds, and some people find later rounds are less effective rather than each round being more effective.


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## faze action (Aug 6, 2009)

I wasn't even aware that a generic version of Xifaxan had been released... when did this happen?http://www.drugs.com/availability/generic-xifaxan.html


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## sonic123 (Jul 5, 2012)

Generic is available in Canada, which is where many US doctors are sending pts. It costs around $130.00 for a 100 count supply of 400 mg generic versus $1,500.00 for a 60 count supply of 550 mg brand name, even in Canada.Kathleen, it sounds like the treatment isn't very effective if SIBO returns for most people and the treatments become less effective over time. Maybe that's why I've been directed to take the antibiotic for 20 days instead of the 10-14 I've read about? Also, I asked if diet should be changed during treatment but dr said no, even tho he said that my high complex carbohydrate actually encourages the bacteria to grow. I'm wondering if there are changes I can make that will facilitate treatment & increase the chances that it will work? Thanks.


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## faze action (Aug 6, 2009)

sonic123 said:


> Kathleen, it sounds like the treatment isn't very effective if SIBO returns for most people and the treatments become less effective over time. Maybe that's why I've been directed to take the antibiotic for 20 days instead of the 10-14 I've read about? Also, I asked if diet should be changed during treatment but dr said no, even tho he said that my high complex carbohydrate actually encourages the bacteria to grow. I'm wondering if there are changes I can make that will facilitate treatment & increase the chances that it will work? Thanks.


Have you looked into a prokinetic? I would not recommend Reglan at all because the side effects are terrible, but I'm taking Iberogast and it does seem to be helping (as far as I can tell). If the SIBO recurs due to a motility issue (just one of many causes), then that needs to be addressed. In terms of diet I've read that, while on the antibiotics, a high-carb diet is encouraged because more of the bacteria die off while they are feeding and carbs (sugar esp.) are their preferred food. Once done with the ABs a low-carb diet is recommended... of course that's just what I've read. My GI doctor also said not to change diet, even after I told him I felt much better gluten-free.


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## sonic123 (Jul 5, 2012)

How do you know if it reoccurs due to a motility issue & not that the treatment was unsuccessful???Have been using a probiotic since the problem began. I use Healthy Trinity or Trenev Trio (sold by physicians only) by Natren. It's the only one that really worked. Check it out. Although I was always told to take probiotic DURING antibiotic tx, dr said it's a waste of money because the antibiotic kills the healthy bacteria taken in with the probiotic. First time I ever heard this.Low carb diet is almost impossible for me since I'm almost vegan except for fish and required to be on a low protein diet. If you cut out carbs, let alone the healthy ones, nothing left to eat. I eat a very low gluten diet because I also feel better doing it, even tho gluten sensitivity serum test 2x showed no problem with it.I just don't want to have to treat this thing more than once (unless there is a motility issue as you say) so want to maximize everything I can do for those 20 days.


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## Kathleen M. (Nov 16, 1999)

If the symptoms of bloating, gas, etc go away after the antibiotic treatment, the treatment was successful, but like you can have a sinus infection more than once in your whole life no matter how dead the bacteria are after the first time, you can get a sinus infection again, especially if you sinuses are built in a way that makes it easier to get one.If your symptoms do not go away, and your follow up breath test is the same badness as before the antibiotics, the treatment didn't work.The bacteria do not recur immediately, it takes awhile for them to build back up no matter how bad the motility is.Antibiotics are indiscriminate killers, but a lot of people seem to find staring the probiotic with the antibiotic works better than waiting until the end.Not sure if it is because not every last strain of probiotics are killed by any given antibiotic, or you happen to get the good guys in ASAP rather than a day or two later, isn't well understood.But you may kill some of the good guys you take with the antibiotics.


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## sonic123 (Jul 5, 2012)

Good to know on the probiotic as this is what I've always done in the past. Thanks for your help, Kathleen. Here's hoping...


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## faze action (Aug 6, 2009)

sonic123 said:


> I just don't want to have to treat this thing more than once (unless there is a motility issue as you say) so want to maximize everything I can do for those 20 days.


If your problem is for sure related to bacteria, then once you're done with the ABs (and if they help at all) low- no sugar would probably be the best thing to do, no matter what else you eat. The sugar is the first thing the bacteria go after...


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## sonic123 (Jul 5, 2012)

Did you know Iberogast is available on amazon.com with free shipping? I had to look it up because I didn't know what it is. Dr. prescribed a different prokinetic for me following antibiotic tx. Did you see Kathleen's answer that many people found that starting probiotic with treatment worked better than waiting until the end? If you want to try Healthy Trinity, cheapest and most reliable place to get it is Vitacost online. They will also ship it with a cold pack. I always upgrade to two day air so I get it when it is still cold. The hardest part for me now is waiting for the darn antibiotic to arrive from the Canadian pharmacy. And I'd still like to know why two gastroenterologists and two very competent alternative medicine drs with whom I consulted numerous times after I developed this problem in 2006 following a FBI never once mentioned even the possibility of IBS or SIBO to me. That is the most frustrating of all.


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## sonic123 (Jul 5, 2012)

I forgot to say that when the problem began, I must have tried at least one dozen probiotic with no luck until I found the Health Trinity.


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## lowimpact (Jul 3, 2010)

sonic123 said:


> Did you know Iberogast is available on amazon.com with free shipping? I had to look it up because I didn't know what it is. Dr. prescribed a different prokinetic for me following antibiotic tx. Did you see Kathleen's answer that many people found that starting probiotic with treatment worked better than waiting until the end? If you want to try Healthy Trinity, cheapest and most reliable place to get it is Vitacost online. They will also ship it with a cold pack. I always upgrade to two day air so I get it when it is still cold. The hardest part for me now is waiting for the darn antibiotic to arrive from the Canadian pharmacy. And I'd still like to know why two gastroenterologists and two very competent alternative medicine drs with whom I consulted numerous times after I developed this problem in 2006 following a FBI never once mentioned even the possibility of IBS or SIBO to me. That is the most frustrating of all.


I hear you i suffered for three years before i got a diagnosis and i had seen two gastros, an internist, a nutritionist, and had numerous tests where no one ever mentioned breath tests. It's worse because i feel like the meds might have worked for me if i had been tested and diagnosed before i had had the problem for three years. You are not alone. I had one doctor tell me i needed to be on antidepressants and get more sleep. I said i'm exhausted because the bloating and stomach issues are ruining my sleep! I'm not depressed if i could get rid of that ! It's a frustrating journey.


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## faze action (Aug 6, 2009)

sonic123 said:


> Did you know Iberogast is available on amazon.com with free shipping? I had to look it up because I didn't know what it is. Dr. prescribed a different prokinetic for me following antibiotic tx. Did you see Kathleen's answer that many people found that starting probiotic with treatment worked better than waiting until the end? If you want to try Healthy Trinity, cheapest and most reliable place to get it is Vitacost online. They will also ship it with a cold pack. I always upgrade to two day air so I get it when it is still cold. The hardest part for me now is waiting for the darn antibiotic to arrive from the Canadian pharmacy. And I'd still like to know why two gastroenterologists and two very competent alternative medicine drs with whom I consulted numerous times after I developed this problem in 2006 following a FBI never once mentioned even the possibility of IBS or SIBO to me. That is the most frustrating of all.


Yep. Been ordering the Iberogast off Amazon for a few months now...I'll check into the Healthy Trinity pro-Bs, although I'm not sure I want to go down that road again (tired of spending money and not getting any help from it).Custom Probiotics are the ones I was using and they did come pretty highly recommended to me by a few people.


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## sonic123 (Jul 5, 2012)

So from what you know, the longer one has the condition, the harder to eradicate? I've never heard this. But you have a step up on me there since I've had it for 6 years. I should clarify - two gastros, one Harvard trained internist, one GP, and two very competent alternative medicine drs who must have known about the condition. But I've noticed something about alternative medicine that was never true before they began to sell expensive supplements. No referrals now to anyone, just a desire to sell supplements every time you go. This is a disappointing trend in alt med.I was advised to take sleep meds, try all kind of prescription goop on my face for the inexplicable rash, and have been taking 12-15 fiber & probiotic a day for the past six yrs just to keep moving. Illnesses like this are hard enough without having the medical community impede their diagnosis & resolution by not being informed or being distracted by their own selfish interests. What are custom probiotics?


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## faze action (Aug 6, 2009)

Here is the CP web site. I was taking the adult CP1 formula.http://www.customprobiotics.com/


> So from what you know, the longer one has the condition, the harder to eradicate?


Was this question directed at me? I don't think this is the case, or I've never been told this by anyone anyhow.SIBO seems to commonly recur (which you already know)... meaning that the bacteria flourish when conditions are ideal (for whatever reason, poor motility, concurrent autoimmune disease, etc). I have never heard that it's harder to eradicate if you are stuck with it longer though. I had SIBO for about 5 or 6 years before I was finally diagnosed, took a course, of ABs and felt great, a few months later the SIBO is back. I do seem to be in a prolonged "remission" right at the moment though.


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## sonic123 (Jul 5, 2012)

Thanks. I have been using the Healthy Trinity 30 Billion strains, which really helped. But I just tried the Align, which is only 1 Billion strains of the Infantis bacteria, with amazing results overnight, better than the Healthy Trinity. The fact that it has sugar and other chemicals in it isn't good at all and the milk protein is cow's milk for those with dairy problems. But Natren does make a completely natural product called LifeStart II, which has double the # of strains of Infantis bacteria (2 Billion per capsule). Natren told me that some people may be born with missing strains of certain bacteria like Infantis, which I thought was interesting. It's apparently a strain I've been missing since this whole problem began.


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## Kathleen M. (Nov 16, 1999)

Technically we are all born missing all strains of bacteria in the gut. Certain ones do tend to colonize babies on certain diets (breast-fed vs formula, etc), but it takes about a year before any baby has a fully developed colon flora.That is why you don't give an infant anything that may have low levels of contamination with botulism bacteria like raw honey. In a toddler, child or adult, they can't grow, but since an infant has very few bacteria of any kind in there, it can and can paralyze and suffocate a child as the diaphragm can be paralyzed as well.


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## sonic123 (Jul 5, 2012)

This makes me wonder because I got very sick when I was around 5 yrs old. Dr took me off milk and I got well. He told me I had an allergy to milk but, in truth, I was always able to eat products with milk in it. So really would not be an allergy. I just wonder if that childhood illness is related to a gut imbalance which caused a lowered gut immunity which led to an eventual vulnerability to FBIs that got me into this situation. Within 48 hrs, Align has completely normalized elimination and I haven't even begun the SIBO yet! I still have a sleep problem and rash on my face but it seems to be the right track. Are you aware of the research by a Gastro Dr Weinstock at Tufts regarding worms and gut immunity? Very interesting stuff.


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## lowimpact (Jul 3, 2010)

sonic123 said:


> This makes me wonder because I got very sick when I was around 5 yrs old. Dr took me off milk and I got well. He told me I had an allergy to milk but, in truth, I was always able to eat products with milk in it. So really would not be an allergy. I just wonder if that childhood illness is related to a gut imbalance which caused a lowered gut immunity which led to an eventual vulnerability to FBIs that got me into this situation. Within 48 hrs, Align has completely normalized elimination and I haven't even begun the SIBO yet! I still have a sleep problem and rash on my face but it seems to be the right track. Are you aware of the research by a Gastro Dr Weinstock at Tufts regarding worms and gut immunity? Very interesting stuff.


Could you post the link to the research you are referring to? I found the Dr and the practice but only clinical trials for other issues and could not find what research you mentioned.


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## sonic123 (Jul 5, 2012)

http://www.tufts.edu/central/research/ResearchNews/Affiliates/Weinstock.html


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## Wonderlust (Aug 17, 2012)

Hello, I am a new member. I believe I have been struggling with ibs for at least 6 or 7 years now. I have seen a gastroenterologist, had the colonoscopy with no abnormal results, been tested for gluten and lactose intolerance, tried probiotics, the antispasmodic buscopan for uncontrollable gas, the FODMAP diet, gluten and dairy free, etc. with no real progress. I have never heard of SIBO until this forum. What exactly is this breath test? Will any doctor order it if requested or would I have to see a specialist again?


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## sonic123 (Jul 5, 2012)

Wonderlust said:


> Hello, I am a new member. I believe I have been struggling with ibs for at least 6 or 7 years now. I have seen a gastroenterologist, had the colonoscopy with no abnormal results, been tested for gluten and lactose intolerance, tried probiotics, the antispasmodic buscopan for uncontrollable gas, the FODMAP diet, gluten and dairy free, etc. with no real progress. I have never heard of SIBO until this forum. What exactly is this breath test? Will any doctor order it if requested or would I have to see a specialist again?


My experience is that you will need to find a gastro specialist who believes that such a diagnosis exists and can direct you to the breath test. I saw two gastro specialists who didn't mention it to me although my history & symptoms were a big red flag. Get Dr. Pimentel's book on the IBS Solution. This will also give a lot of info.


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