# Rifaximin\antibiotic users



## SpAsMaN* (May 11, 2002)

Pete,T.P.others?What should i expect?What dosage do you take?Does it help to reduce C?


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## 19282 (Jul 19, 2005)

Hey there, Spasman - My doctor put me on a 10-day course of Rifaximin. Each pill is 200 mg. I took a total of 800 mg each day (400 in the morning, 400 at night). I just finished my last dose last night.What can you expect? Well, I've always suffered from D (never C, never A) and the Rifaximin gave me looser stools, more urgent stools, the feeling of not being empty (and some moderate headaches and nausea - but only for the first 2 days). Because my GI said not to use Imodium until I finished the prescription, my day-to-day life was a little challenging for about a week. Since my system moves quickly enough as it is, I can't even imagine how my body would have reacted if I took Zelnorm, too.However, over the last two days I've noticed a significant improvement in all my symptoms. In fact, yesterday - for the first time in my adult life - I did not have a single bowel movement (I wasn't constipated. I just didn't feel the need to go. It was one of the happiest days of my life). I hope it lasts, but it's too soon to tell.TP


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## SpAsMaN* (May 11, 2002)

Thanks T.P.,apparently Rifaximin works *best alone*.So your doctor have done a good job apparently.You could feel better for 2 weeks but i don't know how you will react.Since you have IBS-D,it is different than me who is mostly "C".I will probably take the same dosage as you.I'm happy that Rifaximin is pro-D beeing C-ers.


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## 19927 (Aug 4, 2005)

I'm 4 days into a 10 day cipro cycle and my GI just got all my lab/scope results and now officially agrees that i have IBS, therefore he has given me a 10-day script for Rifaximin. I'm supposed to finish my cipro, see how i feel, perhaps wait a week, and then start the rifaximin if the cipro didn't work. I'm glad to hear that it might take a while for the antibiotics to work, as i'm not really feeling any positive results yet. Perhaps my bloating and gas are diminished, but it's hard to say, as symptoms vary all the time anyway.


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## SpAsMaN* (May 11, 2002)

T.P.It seems that you should take 3x 400mg.That may explain your mixed results.Here the research(thanks to Eric to post it):http://ibsgroup.org/eve/forums?a=tpc&s=500...04561#737104561


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## 19282 (Jul 19, 2005)

Thanks Spasman (and Eric)The case for 3x400 does look convincing. I'll print it up and show it to my GI asap to get his opinion.


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## SpAsMaN* (May 11, 2002)

It seems be.


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## Pete (Jan 20, 2000)

Mine told me 600mg 3x a day if I could tolerate it. If not then 400mg 3x a day. I did fine and had no side effects other then my gas and bloating went away. I now take 200mg a day maintenance and symptoms are creeping back a tiny bit. Might need 400mg maintenance.


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## 19282 (Jul 19, 2005)

So I was looking at the study that Eric originally posted and couldn't stop myself from doing a little analysis.The findings showed 1,200 mg a day worked better than 800 mg a day (my dose) in treating SIBO. BUT, in the study the course of treatment was only 7 days whereas mine was 10.5 days. With the help of my calculator, I see that both avenues result in a net total of 8,400 mgs of Rifaximin. Here's my question: Is a longer, sustained Rifaximin campaign as effective as a shorter but more concentrated course of treatment? I've got a call in to my GI to try to find the answer.Pete, how many days did you take 600mg 3x a day? Thanks.TP


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## 19927 (Aug 4, 2005)

So, T.P., how do you feel today? Still feeling improved?


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## 19282 (Jul 19, 2005)

Thanks for asking. Leaving the house to do some errands this morning, I had some looseness. But since then, I've felt really good. The one thing I can tell you for sure is that my body seems to be producing and expelling much less "stuff" each day than it used to since I've been on the Rifaximin. And in my book, that's a good thing.TP


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## 17176 (Mar 31, 2005)

every time i take anti-biotics i end up feeling worse than i did before i took the damn things


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## cat crazy (Jan 28, 2002)

joolieThis may sound mundane, do you take probiotic when you are taking a/b, or right after ending the course of a/b?


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## cat crazy (Jan 28, 2002)

> quote:Originally posted by SpAsMaN*ete,T.P.others?What should i expect?What dosage do you take?Does it help to reduce C?


Spas, I have not read all the posts today or the past couple of days. So you have to excuse me for asking. Did you get your breath test results back and they were positive?Which a/b are you taking?


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## SpAsMaN* (May 11, 2002)

I'm positive to SIBO.Tommorrow,i will see my doctor to schedule another Lactulose breath test after my course of antibiotic.Bonnei,what do you think about it?I have buy Rifaximin on line and it's coming.


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## cat crazy (Jan 28, 2002)

SpasWhich antibiotic your doc gave you for SIBO and tell us the dosage and duration.


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## SpAsMaN* (May 11, 2002)

In fact,i follow the Pete advice which are quite similar to the Eric study link.


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## cat crazy (Jan 28, 2002)

SpasAre you teasing me? Tell me the name of the antibiotic. You know here in Canada Rifixamine (sp) is not available, so again which one you are taking? And how are you responding to the a/b, how are your symptoms now?


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## SpAsMaN* (May 11, 2002)

I have buy Rifaximin on line,i should have it in one week.My symptoms are the same,i'm not on it rigth now.


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## cat crazy (Jan 28, 2002)

Oooh this is exciting. I want to get that lovely Rifaximin. Do you need a doc's prex for it or you can just order it yourself. Please God. let me have the Rifaximin so I can get me life back!


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## 17176 (Mar 31, 2005)

hi hannah i dont take pro-biotics, i did but could not find one that agreed with me.


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## cat crazy (Jan 28, 2002)

joolieAwww. That's too bad. Does plain yoghurt help at all when you're on a/b?.


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## SpAsMaN* (May 11, 2002)

Anna,i can't tell you if this will cure anybody at this moment.If you want,put your adress e-mail in this post so i will send you the link for the pharma business.No,you don't need a prescription.BUT you will probably need a breath test to confirm the SIBO.I understand how you feel.I know the breath test are very rare.I don't want to put the pharma link directly here.I want them to process my order in priority and don't want them to be judge becoze they don't ask for prescription.I will give the link but not rigth now.


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## 19927 (Aug 4, 2005)

Well, I'm seven days into the Cipro trial and i still have gas, some bloating, and i can still feel my guts moving around. Maybe this is an improvement, maybe not. I've forgotten what my guts are supposed to feel like, but i don't think they should be constantly snaking around inside my abdomen.I was really hoping that all my symptoms would be gone by now. Oh well, i have the rifaximin ready to go after the cipro trial is over, but from what i've read, they should both work equally well, only the rifaximin has less of a chance of causing other problems in my system.


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## SpAsMaN* (May 11, 2002)

So Pete would you mind to give an update?Here some articles about long term antibiotic:http://www.mi-marr.org/http://www.shasta.com/cybermom/longterm%20antib.htm


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## SpAsMaN* (May 11, 2002)

A dermatologist gives his opinion at least for Erythromycin to a patient:http://www.medhelp.org/forums/dermatology/...ges/30600a.html


> quote:From To Post Andrew06/27/2000 . Are there necessarily bad side effects to long term use of, say, erythromycin or tetracycline? Do people always become resistant to it? I have heard of such horror stories as "gram-negative" folliculitis to yeast infections to compromised immune systems. I am being treated for acne and am concerned about taking these drugs long-term. Currently I take erythromycin and have for about a year.Thanks for your time Derm M.D. ASR06/27/2000 Andrew Andrew:I think you don't have much to worry about. In general, long-term antibiotic use, especially with an antibiotic like erythromycin which is not broad-spectrum, is not associated with problems like weakening the immune system, susceptibility to colds, and so forth. Once your acne has cleared up, of course, it's best to stop. Sometimes people go on for years after their acne has departed, for fear it will return.Best.Dr. Rockoff


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## 19927 (Aug 4, 2005)

I finished my Cipro this morning (10 days). I had two near-perfect days on the eighth and ninth day of the cipro: normal stool (one trip to the bathroom), no gas, very little bloating. But then last night, the last night of my antibiotic cycle, i had a lot of gas, so now i'm disconsolate. My BMs are still normal, but since gas is my biggest problem i don't know what to think. I'm starting the rifaximin (600mg, 3 times a day, for 10 days) on Monday, but since any benefits from the cipro didn't even last through the course, I'm not expeting much.


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## SpAsMaN* (May 11, 2002)

You are doing the rigth thing.I wait for Rifaximin from the mail.I expect a real improvement but i think i may need a maintenance dose after the course.


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## SpAsMaN* (May 11, 2002)

We have talk a lot about Rifaximin and others antibiotic recently.Here few link to explain how to take them:http://www.consumerreports.org/main/crh/di...older_id=387119http://ibscrohns.about.com/cs/antibiotics/...bioticssick.htm


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## SpAsMaN* (May 11, 2002)

Bonnei,what are you gonna do now since the "magic goes away"?If i were you i would try a maintenance dose or a prokinetic.A long term antibiotic treatment for SIBO?Is there a life after a course?


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## 19927 (Aug 4, 2005)

I'm starting my rifaximin trial today. 400 mg three times a day for 10 days. Let's hope this works better than the 10 days of Cipro. By the way, it appears that the cipro did some good--all my symptoms are less noticable than before--but i still have them, so now all my hope is in the rifaximin.


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## bonniei (Jan 25, 2001)

I am waiting for the test and the visit with Dr Rao. I will ask him for a maintenance dose then. Good luck wornout.


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## 19282 (Jul 19, 2005)

Wornout - I'm very curious to hear how the Rifaximin treats you. I took my last dose eight days ago. (As I've mentioned, I was taking a lower daily dosage than you - only 400mg twice a day for 11 days.)Despite having a couple of really good days, I've also had a couple of bad days (where my symptoms have been worse than before I started taking the stuff). When I called my GI last week to ask about this, he said that it could take some time for my body to "re-calibrate" itself after the course of antibiotics. I'll have to wait and see about that.Anyway, I hope the Rifaximin gets rid of your symptoms for good. Please keep us posted. Thanks.


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## 18749 (Jun 15, 2005)

Spasman, can you send me the link for the online pharmacy you used? I've put my email address below.Have you received the pills yet? I'd be interested to hear if they work for you.Thanks! Juliejhol1976###hotmail.com


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## bonniei (Jan 25, 2001)

Julie, I would not recommend antibiotics until you can get a before/after breath tests as well as motility agents to prevent the relapse of SIBO. Or else you will be in and out of your doc;s office every few weeks to maintain the improvement. Is it worth it to become antibiotic resistant or expose yourself to C-difficile(although Rifaxinmin) has a good profile for both) for a couple of weeks of worth improvements? Please be cautious.


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## SpAsMaN* (May 11, 2002)

I think Bonnei gaves good advices.Automedication is not always good.But i understand how people can be frustrated about the rarety of breath test,IBS etc..No i haven't receive the meds.Pooped out,how old are you?What makes you think you need antibiotics?


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## SpAsMaN* (May 11, 2002)

hmmm i see pooped,you was the 28years old woman that i have met in the young adult forum.Do you have bloating?At least i have a doctor who can prescribe me Erythromicin as a prokinetic if i need it after my course.I also have a bottle of Zelnorm if (by a miracle)the sensitivity would go away during the course i could handle it.


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## 19927 (Aug 4, 2005)

It's clearly best to do things right. But i'm not. And here's why. There are very few anecdotal reports on this board that suggest people are cured by a/b, or are even catagorically relieved. But in the few cases where anectodal evidence does exist, people felt cleared up of their symptoms pretty quickly. This is not perfect science, and i know that the recent Pimentel/Lin paper suggests that some see improvements after the course of a/b has ended, but it does mean that if a person wants to know if their guts will respond to a/b treatment than a quick and easy way to do so is to get a hold of rifaximin. This is what i did and am doing. If i see an improvement in my symptoms than i will see about maintaining my improvements. Since every visit to my GI costs me a chunk of cash and since breath tests are not universally available it makes sense to me to just do the rifaximin and then see what happens. One last thing--and this seems especially true after reading today's article in the NY Times-- it just seems unlikely that antibiotics will cure us. It's such an easy, common, and obvious response to gut problems. If it really was the cure for 50-80% of IBS'rs than it seems likely someone would have stumbled on it long ago. I'm hoping, and taking the rifaximin, but i'll be really surprised if all this SIBO stuff pans out.


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## 19927 (Aug 4, 2005)

Itâ€™s day two and I still have IBS, though gas is my only symptom. Iâ€™ve taken five doses of Rifaximin so far and I have no adverse reaction to it. I generally donâ€™t have any problems with antibiotics. Despite the pessimism of my previous post, Iâ€™m still hoping that this all works out. I bought the Lin paper, â€œManagement of Small IntestinalBacterial Overgrowthâ€ and found the section that Bonnieie has mentioned. Iâ€™m posting it here for T.P. 923, since it might apply to him, and perhaps me too.


> quote: Symptoms during treatment may paradoxically worsentransiently before they improve. Different therapeuticapproaches are associated with different patterns of exacerbationand subsequent improvement. With a course oftraditional systemic antibiotics, symptoms may worsen fora couple of days 3 to 4 days into the treatment, followed byresolution of symptoms, which may be delayed until 2weeks after completion of treatment for gastrointestinalsymptoms and up to 2 to 3 months for extraintestinalsymptoms after completion of the antibiotic course. Treatmentwith an elemental diet and a nonabsorbable antibioticoften produces an exacerbation of symptoms afterabout a week, followed by normalization.Because there is a lag in the resolution of symptoms,symptomatic improvement alone cannot be used as theprimary indicator of successful treatment when the patientis seen 2 weeks after completion of a therapeutic intervention.


It's hard to say if he means that with a nonabsorbable a/b OR with an elemental diet symptoms get worse after a week, or if he means with a nonabsorbable a/b in conjunction with the elemental diet. I don't know.


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## SpAsMaN* (May 11, 2002)

I'm almost sure Wornout,separatly.I have never heard of Antibiotics+elemental diet(Vivonex plus).


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## 18749 (Jun 15, 2005)

Hi everyone and thanks for the advice. Frankly, I don't know that I would order the antibiotics without seeing a doctor first, but it somehow made me feel better to think that I could get them if I needed to.I'm just getting really frustrated by the IBS and the healthcare system, and am feeling desperate to give anything a try that might work. I figure antibiotics aren't that dangerous to try ... as long as I only have one course of treatment to see if they help I won't become resistant to them, and if they help, I can let my doctor know.I thought it was maybe worth a shot to see if I have SIBO. I have D, pain, gas and bloating. I will be speaking to my GI about it, but can't get an appointment with her until mid-November! I've had no life for about 10 months now since it flared up badly again, and am getting desperate as I said. I don't believe that SIBO is necessarily the answer, but I thought it was worth ruling out.Let us know how you're doing on the a/b.


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## bonniei (Jan 25, 2001)

Pooped out An alternative to antibiotics is 14-21 day elemental diet(Vivonex Plus). It as been known to be useful in normalizing the breath test which is predictive of symptom relief. http://www.ncbi.nlm.nih.gov/entrez/query.f...t_uids=14992438Why an elemental diet might be useful for SIBO1)it dramatically increases bile output. Bile is known to have stimulatory effects on phase III MMCS2)It is possible that the immune effects of the diet might rid the SI of bacteria3)The composition of the diet by itself may have an adverse effect on the bacteria.You need to have only Vivonex pplus for 14 days. It is terrible to taste but it is available only and probably in your pharmacy and if you are desperate.


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## 19282 (Jul 19, 2005)

Wornout - Thanks so much for posting those excerpts from the Lin paper. The information about the exacerbation of symptoms and the lag in symptom resolution is encouraging. After my post last night, I experienced one of the most sudden and uncomfortable bouts of cramping and subsequent diarrhea I've ever known (in 17 years with IBS, cramping had never been a frequent symptom of mine). Today, however, was a completely different story. I swear that my bowels have never felt calmer. Since I'm closing in on the "2 weeks after completion" mark refered to in the paper, I really hope that this might be the "normalization" finally kicking in. Anyway, thanks again for sharing this helpful info.


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## SpAsMaN* (May 11, 2002)

T.P. have you been diagnose with SIBO?I don't know what to think.Bonnei,i think i would have to guess my SIBO level since i'm not really interested in beeing sick again from Lactulose.


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## 19282 (Jul 19, 2005)

Yes, hydrogen breath test (using glucose).


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## 19927 (Aug 4, 2005)

Well then,T.P., let's all hope this calmness continues for you. You're our best indicator of what's to come, so keep us posted.


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## bonniei (Jan 25, 2001)

> quote:Bonnei,i think i would have to guess my SIBO level since i'm not really interested in beeing sick again from Lactulose.


I don't follow. Are you thinking of taking lactulose instead of antibiotics. That is another alternative. I was suggesting Vivonex Plus


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## bonniei (Jan 25, 2001)

T,P, I thought you used sucrose


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## 19282 (Jul 19, 2005)

Bonniei - My mistake. Sucrose is the correct. There's a reason I'm not a doctor.


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## bonniei (Jan 25, 2001)

> quote:Bonnei,i think i would have to guess my SIBO level since i'm not really interested in beeing sick again from Lactulose.


I think i just understood what you were saying. You don'rt want to do the second breath test because you get sick from lactulose. Second breath test is the only objective measure you have.


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## SpAsMaN* (May 11, 2002)

First dose 200mg 5-PM eastern time.


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## 22663 (Aug 17, 2005)

Quote:"First dose 200mg 5-PM eastern time."Good luck Spasman. I hope you have positive results.


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## SpAsMaN* (May 11, 2002)

Hi.First "gut" reaction:I'm a little bit too energetic.I don't know if it is positive or not.I mean i was doing work outside in a hurry which usually,is heavy.


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## 19927 (Aug 4, 2005)

Good luck, and remember to relax and let it take time. Also, why not 400mg?


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## SpAsMaN* (May 11, 2002)

I'm one of the most sensitive IBSers here.So i start slowly any new treatment.200mg is the normal dose on the box.But even this seems to boost adrenaline or something.I often got this stupid reaction with my trials.I don't know anymore,100mg or less?


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## 19927 (Aug 4, 2005)

So, are you planning to go the full month on the 600mg/day plan?No, i think you should stick with the full dose, even it it makes for a rough time. If this is the cure than it's be worth it, If not, than the weeks will past, as they always to, and you'll look back on a hard time, but isn't most of our life a hard time now anyhow?


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## SpAsMaN* (May 11, 2002)

That's true IBS is unpleasant anyway.Now the things has settle down.Do you have side effects wornout?Where is Pete?


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## 19927 (Aug 4, 2005)

Yeah, i have side effects, but i have considered them not worth mention. But here they are: i feel wired like i've taken too much cold medicine, i feel a bit feverish, i feel a bit winded after simple activities and i feel overly sunlight sensitive.


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## 19282 (Jul 19, 2005)

Hey everybody. Thought I'd throw in a quick post-Rifaximin update. Today was another great day for my symptoms. That's two in a row now. I even managed to sit through a haircut today without any of my usual anxiety-triggered urgency (no Imodium taken, either).I don't know if this is a relevant factor in my symptoms getting better or not, but I've also been eating a little bit of yogurt each of the last few days. For all I know, eating yogurt could be a gross violation of the Pimental protocol. But I've heard that helps restore the bacteria balance in the GI tracdt after taking antibiotics.TP


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## 19927 (Aug 4, 2005)

That's great news. But, for God's sake Man, stay off the yogurt. Actually i had a few servings of yogurt during the three days between a/b courses and then remembered Pimentel was opposed to it. Well, we're all hoping your remission continues.


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## 19282 (Jul 19, 2005)

Is he seriously opposed to yogurt? I was just taking a stab in the dark - half kidding, really. Once again, like George Costanza on Seinfeld, my instincts turn out to be dead wrong.TP


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## 19927 (Aug 4, 2005)

Apparently, he doesn't like probiotics. On the containers of the four cups of Yoplait i just had, i noticed that they were touting the fact that the Youplait contained acidophilus, which is what, i believe, probiotics are full of. So, i imagine Pimentel is opposed to them, but i also imagine that probiotic tablets have a lot more bacteria than a cup of yogurt.


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## Kathleen M. (Nov 16, 1999)

I think the most recent meetings he was at where Flux got to see the presentation he was much less opposed to probiotics than he used to be.I think when he started it was bacteria are bacteria and you shouldn't add any back in.Yes, some versions of probiotic bacteria are the same ones that turn milk into yogurt.I did a lit search (and it sounds like Pimental probably has to given the change in stance) and probiotic bacteria in animals are used in feed to help with bacteria in the small intestine (feeding the probitoics increases weight gain and stuff that excess bacteria in the small intestine can make worse)Also any carbs the probiotic bacteria eat cannot be turned into gas by the other bacteria in there. For some people taking probitoics greatly reduces gas out put (it does for me from 30+ farts a day to less than 5). At least some of the problem in SIBO seems to be the gases produced in the small intestine.So I think the jury is out on whether they hurt or help. One of Pimental's early patients on here, Pete, actually did really well on VSL#3 which is a probiotic formula.Unfortunately we don't have a good probiotic and SIBO study, but for some of the IBS studies they help for the same sorts of symptoms SIBO seems to be causing.K.


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## SpAsMaN* (May 11, 2002)

Back to 100mg.Geez it is gonna be a long week.


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## SpAsMaN* (May 11, 2002)

How do you guys cope with Rifaximin?Do you sleep all the time?It seems to help C at least but a little bit irritated in the bowel.:-/


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## bonniei (Jan 25, 2001)

Change the dose only under the supervision of docs. Do you know that if you don't finish the required dose to kill the bacteria, you can build resustant bacteria.? Please be careful.


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## 19927 (Aug 4, 2005)

No, i don't sleep all the time, but i've stopped going to the gym, and taking my dogs for walks because i get winded. Stay on the full dossage, Spas. It's only for a week or two. Unless, or course, your reactions are so strong you're going to end up in the hospital. Be strong, man.


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## 19282 (Jul 19, 2005)

It's strange, but I actually went through a bout of insomnia when I was on the Rifaximin, so I didn't sleep much at all. I didn't feel fatigued or winded, either. My biggest side effects were headaches and urgent diarrhea. Interesting how we react differently to the same stuff.Good luck, Spas.


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## SpAsMaN* (May 11, 2002)

I'm on 100mg and it possibly the higher dose i can handle.My body didn't like what is not absorbed like Lactulose or Rifaximin.







Rifaximin makes me "intoxicated".I don't feel better.I would like to take another antibiotic less heavy,for instance Apo-Cefuroxime which i took this year who has improve my IBS with only D and urgency as a side effect.


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## SpAsMaN* (May 11, 2002)

In fact at 100mg,i don't suffer much more than my usual IBS.I'M just more tired and crappy.


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## SpAsMaN* (May 11, 2002)

> quoteo you know that if you don't finish the required dose to kill the bacteria, you can build resustant bacteria.?


What do you mean??


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## 22663 (Aug 17, 2005)

quote:


> quote:In fact at 100mg,i don't suffer much more than my usual IBS.I'M just more tired and crappy.


Spasman, does this mean you have reduced your dose down to 100mg or are you going to try to stick to the higher dose?


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## bonniei (Jan 25, 2001)

spasman, it is like if you don't kill them they get all the data of the antibiotic and adapt to it to create resistant strains.


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## SpAsMaN* (May 11, 2002)

I will probably stick to 100mg and change the med monday when i will talk to my specialist.Or drop everything as usual.


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## SpAsMaN* (May 11, 2002)

Bonnei,you mean to take no prisonners of war if you know what i mean


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## SpAsMaN* (May 11, 2002)

Yea i feel the war inside







But I don't i want to see them figth yuck!














-If you find the T-shirt funny;http://www.cafepress.com/healingwell


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## 19927 (Aug 4, 2005)

I don't want to step over a line here and be insulting, if i am i don't mean to be, so i apologize in advance. But Spaz and Bonniei, your sudden backtracking on this SIBO treatment when both of you are apparently really suffering and have been posting here for, literally, years, confuses me. IBS is killing me: it's ruining my social life; it's put my career on hold, and it's put a strain on my marriage. Why on earth would you stop now when there's actually some hope of not only reducing symptoms but of understanding the physical problem? It's seems crazy. I would undergo ten days of blindness, if that's what my side effects were, to try a treatment that offered some real hope. Don't you want to feel better?Spaz, can you better explain exactly why you can't handle the rifaximin? I'm not really sleeping, and i have all the side effects i've mentioned in a previous post, but no problem--it might offer me a chance to rejoin the world. I swear to god i'd cut two fingers off to feel better. Are your side effects that bad?Again, i don't mean to push too hard; i'm just having trouble understanding anything less than a full out war on IBS. By the way, i've had two symptom-free days. I would like to say the rifaximin is working, but who knows, perhaps it's a placebo effect and i don't want to get hopes up yet.


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## SpAsMaN* (May 11, 2002)

I often got this reaction:One time with Dilaudib,Melatonin 3mg etc...It's like beeing on Adrenaline or something.I think i can't handle the toxins.I don't know.More than unconfortable.100mg is my dosage.Everyone is different.


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## cat crazy (Jan 28, 2002)

About maybe 2 years ago I had heard in the news on t.v that tabacco leaves were being tested/tried for ibs. Never heard anymore again. Wonder what happened to that research. Maybe then marijuana also helps, in the pain part of ibs and the serotonin field. Yikes hope this post does not offend anyone. I am just a very curious gal.


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## SpAsMaN* (May 11, 2002)

I'm still on 100mg.My IBS still there but like most antibiotic do,i feel less stools stuck and less constipation which is cool.I'm not confortable but i find cool to be not stuck.I would like to take another antibiotic less heavy,for instance Apo-Cefuroxime which i took this year who has improve my IBS with only D and urgency as a side effect.


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## SpAsMaN* (May 11, 2002)

Wornout,are you able to work full time on Rifa?Geez,i hope there is a bathroom close to you.Or perhaps you have a portable toilet.














I have one,i wonder if i could drive with it in my truck without spreading the chemical solution over the place.


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## SpAsMaN* (May 11, 2002)

http://www.endonurse.com/hotnews/55h2514535580088.html


> quote: Small Bowel Bacterial OvergrowthLeonard Baidoo, MD, Graduate Hospital, Philadelphia, PA, et al., investigated the efficacy and tolerability of rifaximin 800 mg daily (400 mg BID) for 14 days in 14 patients with lactulose breath test-documented small bowel bacterial overgrowth. Patients in the study had underlying diagnoses of Crohn's disease, scleroderma or mixed connective tissue disorder. In this open label study, mean time to onset of response was four days and mean time to complete remission was 10 days. Thirteen of the 14 patients responded, and 92 percent of responding patients had complete remission and 8 percent reported a greater than 50 percent response. Mean bowel frequency decreased from nine daily to two daily, and all patients reported decreased fecal urgency and complete resolution of abdominal pain. No adverse events were reported.


Gastric acid suppression does not promote clostridial diarrhoea:http://qjmed.oxfordjournals.org/cgi/content/full/93/3/175Antibiotic-associated diarrhea:http://www.cnn.com/HEALTH/library/DS/00454.html


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## 19927 (Aug 4, 2005)

I'm actually going to the bathroom less with the rifaximin than without. I'm feeling wired and not sleeping well, but my guts seem better. Last night, however, after two symptom free days, i had some gas. This really upset me. If i didn't have IBS, the gas i had would have been no big deal, but since i'm expecting to feel better each day i take the a/b, it really upset me.


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## 19927 (Aug 4, 2005)

I wonder how T.P. is doing; he's the furthest along on the a/b trials. Give us an update, T.P.


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## SpAsMaN* (May 11, 2002)

Gas is a side effect:http://www.salix.com/products/products_xifaxan.aspThe odor is quite bad but i didn't noticed an increase in volume.


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## SpAsMaN* (May 11, 2002)

There is some polyethynel glycol(Miralax) in Rifaximin,maybe that's the ingredient who cause me problem.


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## 19282 (Jul 19, 2005)

Yesterday I had a bad morning. As I was trying to leave the house, I got hit with some urgency, uncharacteristically bad gas, and some really loose (and mostly un-formed stools).Unfortunately, I'm hesistant to draw any Rifaximin/SIBO conclusions from this episode because the night before, I made some ill-advised food/beverage choices that included a beer, a bean burrito, and, of all things, an ice cream sandwich. (For the record, NO probiotics/NO yogurt). Ordinarilly I wouldn't have eaten that stuff, but I'd been feeing so confident after having a few GREAT days that I guess I was beginning to believe that I was bulletproof. For what it's worth, I had no problems for the rest of the day yesterday. And so far today, everything feels A-OK.


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## SpAsMaN* (May 11, 2002)

> quote:Yesterday I had a bad morning. As I was trying to leave the house, I got hit with some urgency, uncharacteristically bad gas, and some really loose (and mostly un-formed stools).


I have this since that i begun Rifaximin.I think i can handle 200mg now but i don't feel confortable at all.Head aches etc...


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## SpAsMaN* (May 11, 2002)

Rifaximin aka XIFAXAN aka Flonorm ingredients:http://www.rxlist.com/cgi/generic/xifaxan.htm


> quote:XIFAXANâ„¢ Tablets for oral administration are film-coated and contain 200 mg of rifaximin. Inactive ingredients are colloidal silicon dioxide, disodium edetate, glycerol palmitostearate, hypromellose, microcrystalline cellulose, propylene glycol, red iron oxide, sodium starch glycolate, talc, and titanium dioxide.


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## SpAsMaN* (May 11, 2002)

I need positive feedback from Rifaximin users please.Pete,T.P.,Wornout etc...Do you improve yes or no and which improvements did you noticed?I take it with food now,i think it is easier for me to absborb the dosage.I'm at 200mg now.


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## Pete (Jan 20, 2000)

I'm still doing well. I did my 14 days and now I've done about 45 days of a 200mg maintenance dose. I'm not cured as I still have some reflux but the gas and bloating are pretty much gone. I do have to stay away from sugar though. I have no side effects and plan to stay on it indefinately. The only weird symptom I have that does not respond at all is anal itching/burning. I manage it with desitin cream and wet wipes but I can't understand what is causing it. I was thinking about starting antifungals. Doc said pruritis ani but that is like a catch all phrase like ibs. Anyone else have this?Thanks,Pete


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## 19927 (Aug 4, 2005)

I'm on my sixth day. I seem to have a bit less gass, but my stomach seems generally upset. I've had some good days, but i've been on vacation, so i might have had those symptom-free days anyhow. If i had to make the call, i'd say that i don't really see any improvement so far. I plan to finish my rifaximin trial and see how it goes, but i don't have really bigs hopes anymore. We'll see.


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## SpAsMaN* (May 11, 2002)

Wow Pete 45 days of maintenance,that's the longest SIBOers treatment that i'm aware of.So what is your improvement in %?Yes Pete,sugar is generally bad.It's in everything,especially soda and juice.I try to use sugar only as an energy source.


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## 19927 (Aug 4, 2005)

I don't want to argue with you, Pete, but if you still have to restrict your diet, than what's the point of the a/b protocol? If sibo is the culprit and rifaximin cures it, we shouldn't have to modify our diet after the rifa cycle. This is day seven for me and i still have IBS.


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## bonniei (Jan 25, 2001)

I do agree with wornout here- if you till need to restrict your diet, where is the point?


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## Talissa (Apr 10, 2004)

I agree too...that's sure the point for me. To eat what I want again. Ahhh.Well, this does make me feel better abt choosing the wrong doctor. He'd only Rx one week of rifaximin at 600 mg/day...said I'd need to visit a GI for the ethical Rx of maintenance use of this drug which is only approved by the FDA right now for 3 day stints for traveller's D....just my luck, had to get an ethical doc.







I had print outs from pub med...he said you can't believe everything you read on the web...don't even think he knew what pubmed was. Grrrr.Haven't taken the week's worth. Can't decide if its worth it...


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## Pete (Jan 20, 2000)

The difference is before if I restricted my diet, I was still miserable. I never said it was a cure but I'll take any improvement to aid my quality of life. I think these problems are very complex and SIBO is probably a result of something else going on. Either way 1 rifaximin a day and no sugar and I'm 80% better and can enjoy life. No rifaximin and I'm bloated and gassy and miserable. I think we should look at this in terms of treatment and not cure.


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## bonniei (Jan 25, 2001)

Talissa, generally the maintenance drugs of choice are Zelnorm/erythromycin-to promote motility. Maybe your ethical doc will prescribe those. I would get the maintenance drugs lined up in case you are 100%$ better with the Rifaximin and you don't want the improvement to go to waste.Hi Pete, I agree that quality of life is important. I guess since I sit at home it doesn't make much of a diff to me. Good to know that you are 80% better. With the a/b (Augmentin) I was 100% better but slowly the symptoms are creeping back in. But I am still doing pretty good. It is now 3 weeks. I would say I am at a 80% improvement, without fructose stil 100% better. I wish I had asked for Zelnorm but I want it to get really bad for the test I have scheduled on Nov 1st.


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## SpAsMaN* (May 11, 2002)

Pete why Rifaximin instead of Zelnorm for maintenance?Rifaximin is not a good motility agent i think.I'm at 400mg 3 x per day.I have Zelnorm here.


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## Pete (Jan 20, 2000)

Spasman,I don't feel well on zelnorm or prokinetics in general.


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## SpAsMaN* (May 11, 2002)

Pete,did you use Zelnorm post-course?Who knows perhaps you are able to tolerate now.














I have drop some today,it was my first bowel plug up since i began Rifaximin.I have push my bowel too hard by eating a banana








.Which are VERY CONSTIPATING.














Does it matter,my Zelnorm is post-dated since 6 months?


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## SpAsMaN* (May 11, 2002)

I have reduce my C/trapped gas attack with Rifaximin.But i still have a long way to go before i reach 80% of improvement.I should finish my course before speculating but i feel i have reach the sealing.Anyway,i continued 400mg 3x per day.


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## SpAsMaN* (May 11, 2002)

I have done my Rifaximin week.Now i use Zelnorm as a maintenance.Erythromycin is on the way just in case.I have always tougth i needed a little help to go but apparently it's not a simple thing.


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## SpAsMaN* (May 11, 2002)

My doctor suggest that i have another Lactulose breath test before i start another antibiotic.I'm not thriled about it.So i take Zelnorm for maintenance now and i still try to figure out what irritate my lower pelvic area.







Perhaps trapped gas.


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## bonniei (Jan 25, 2001)

oh thank goodness you consulted your doc.I think it is a very good idea to do the lactulose test again.


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## eric (Jul 8, 1999)

FYIDigestive Diseases and Sciences, Vol. 50, No. 8 (August 2005), p. 1461 ( C 2005) DOI: 10.1007/s10620-005-2861-9 LETTER TO THE EDITOR IS THE PREVALENCE OF SMALL BOWEL BACTERIAL OVERGROWTH IN PATIENTS WITH IRRITABLE BOWEL SYNDROME INCREASED? THE QUESTION REMAINS UNANSWERED To the Editor: Pimentel et al. attempt to compare the small bowel motility in patients with irritable bowel syndrome (IBS) with small intestinal bacterial overgrowth (SIBO) and normal controls (1). They conclude that there is a significant difference in the prevalence and characteristic of phase III of the migrating motor complex (MMC) between the two groups. Furthermore, a difference in motility was found between IBS patients with persistent or eradicated SIBO. A number of concerns arise regarding the validity of these findings. This is a caseâ€"control study. Two parameters are essential to the validity of caseâ€"control designs: (a) appropriate selection of cases and controls and (







adequacy and comparability of the data obtained. In general, cases should be selected to represent the larger population. One wonders whether patients with IBS refered to a major motility program at a tertiary center are representative of the average patient with IBS. The idea behind selecting controls is to find a group of individuals who are similar to the cases and come from the same general population but do not have IBS. In this study, there are major differences between the case and the control groups including the average age (45.4 for cases vs 26.0 for controls), female gender (74% for cases vs 43% for controls), and geograhic location (Los Angeles, CA, area for cases and Cleveland, OH, area for controls). Some of the issues regarding the adequacy and comparability of data are addressed by the authors including the use of two different small bowel manometry systems and different positioning of the manometry catheter in the cases and controls. One can also argue that the average recording time of 227 min used in this study is too short considering that the active front of the MMC occurs on average every 84 to 112 min (2). The accuracy of the lactulose breath test to diagnose SIBO in patients with altered motility further raises concerns regarding the validity of results in this study. Indeed the sensitivity and specificity of the hydrogen breath test are considered by many experts to be unacceptable for detection of SIBO (3). SIBO can be underdiagnosed with the lactulose test because many bacteria do not produce hydrogen, and on the contrary, an overdiagnosis can occur because of rapid transit of lactulose to the colon (4). We believe that the hypothesis of association between IBS and SIBO is very interesting and deserves evaluation under rigorous methodological standards. PETER DRAGANOV, MD PHILLIP TOSKES, MD Department of Gatroenterology Hepatology and Nutrition University of Florida Gainesville Florida 32610-0214, USA REFERENCES 1. Pimentel M, Soffer EE, Chow EJ, et al.: Lower frequency ofMMC is found in IBS subjects with abnormal lactulose breath test suggesting bacterial overgrowth. Dig Dis Sci 47:2639â€"2643, 2002 2. Vantrappen G, Janssens J, Hellemans J, Ghoos Y: The interdigestive motor complex of normal subjects and patients with bacterial overgrowth of the small intestine. J Clin Invest 59(6):1158â€"1166, 1977 3. Bishop WP: Breath hydrogen testing for small bowel bacterial overgrowthâ€"a lot of hot air? J Pediatr Gastroenterol Nutr 25(2):245â€" 246, 1997 4. Corazza GR, Menozzi MG, Strocchi A, Rasciti L, Vaira D, Lecchini R, Avanzini P, Chezzi C, Gasbarrini G: The diagnosis of small bowel bacterial overgrowth. Reliability of jejunal culture and inadequacy of breath hydrogen testing. Gastroenterology 98(2):302â€"309, 1990 Digestive Diseases and Sciences, Vol. 50, No. 8 (August 2005) 1461 0163-2116/05/0800-1461/0 C 2005 Springer Science+Business Media, Inc.


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## SpAsMaN* (May 11, 2002)

I don't know Bonnei.Been so bloat with Lactulose.If it is a laxative like Flux claims,it is not a good one.I felt constipated the nigth of my breath test.Very trapped with gas.The only treatment that i know to reduce sensitivity is anti-depressant.







Perhaps i have mild infflammation not visible on the scope.


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## bonniei (Jan 25, 2001)

The dose for constipation is much higher- upto 60 ml while for the test only 12 ml is used.


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## SpAsMaN* (May 11, 2002)

Interesting...I don't know people who uses it.I'm amaze how many doctors i have seen and are clueless.It's not that unusual,pubis bloat.


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## SpAsMaN* (May 11, 2002)

Perhaps i could take Erythromycin low dose along with probiotics to evoid C-difficile.I'm doing research on the treatment of antibiotic against constipation,there is not much info on it.Of course,on the french board a girl suggest me herbs therapy.Not much faith on it for now.


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## bonniei (Jan 25, 2001)

spasman, when is your breath test scheduled?


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## SpAsMaN* (May 11, 2002)

dunno.It's 3 hours from here.


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## bonniei (Jan 25, 2001)

good luck! Let us know when yu have it set up. I am really curious as to how you do on the test. Don't wait too long!


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## SpAsMaN* (May 11, 2002)

Bonnei,about resistance,again:A dermatologist gives his opinion at least for Erythromycin to a patient:http://www.medhelp.org/forums/dermatology/...ges/30600a.htmlquote:From To Post Andrew06/27/2000. Are there necessarily bad side effects to long term use of, say, erythromycin or tetracycline? Do people always become resistant to it? I have heard of such horror stories as "gram-negative" folliculitis to yeast infections to compromised immune systems. I am being treated for acne and am concerned about taking these drugs long-term. Currently I take erythromycin and have for about a year.Thanks for your time Derm M.D. ASR06/27/2000Andrew Andrew:I think you don't have much to worry about. In general, long-term antibiotic use, especially with an antibiotic like erythromycin which is not broad-spectrum, is not associated with problems like weakening the immune system, susceptibility to colds, and so forth. Once your acne has cleared up, of course, it's best to stop. Sometimes people go on for years after their acne has departed, for fear it will return.Best.Dr. Rockoff


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## bonniei (Jan 25, 2001)

I think you are relatively safe with erythromycin especially since it is a low dose. I don't think Pimentel would have used it otherwise.


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## SpAsMaN* (May 11, 2002)

My theory on SIBO:Sibo eradication sucess rely on liquid diarrheainduced by a treatment such some kind of antibiotic followed by a pro-motility agent maintenance to keep the bowel in proper peristaltic.The goal is to flush the bad guys who overload the digestive system,and keeping them undercontrol with the pro-motility agent.


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## bonniei (Jan 25, 2001)

Another way of looking at it is when the bad bacteria are flushed out, they are no longer there to produce substances which produce diarrhea. So I don't thibk succes is measured by antibiotic induced diarrhea


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## SpAsMaN* (May 11, 2002)

Bonnei,i can basically tell you from how i feel now that i will have another positive Lactulose.I may have been negative earlier this year but that has been with Cefuroxime.See my post on the C forum.


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## SpAsMaN* (May 11, 2002)

> quote:when the bad bacteria are flushed out, they are no longer there to produce substances which produce diarrhea. So I don't thibk succes is measured by antibiotic induced diarrhea


Then,only for C-ers and/or bloaters?


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## bonniei (Jan 25, 2001)

> quote:I may have been negative earlier this year but that has been with Cefuroxime


The only way to tell is with the actual test. As I keep on saying it could have been a side effect/ How long did the good days last 3 weks atleast? If it camre baxk immediately, it could have been a side effect.


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## SpAsMaN* (May 11, 2002)

> quote: it could have been a side effect.


Hmmmmm the side effect(D) was probably the flushed out of the bacterias enligthning the dysbiosis







theory...Since Cefuroxime has no prokinetic value(From Flux claims).







Here the F comment on resistance(again not consistant?







):http://ibsgroup.org/eve/forums/a/tpc/f/431...09661#460109661


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## bonniei (Jan 25, 2001)

Why do you think flux's comment is inconsistent?


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## SpAsMaN* (May 11, 2002)

First,Flux call it hyperbiosis rather than dysbiosis







: my mistake.







http://ibsgroup.org/eve/forums/a/tpc/f/431...m/485103561/p/4And F on resistance:


> quote: Bacterial resistance was apparently a nonissue because the logic is to combine it with prokinetics which gets the gut going. But in your case, the colon is where the action is. I'm not sure if you could alter that en masse with antibiotics. Perhaps in combination with some probiotic. Or I got it, a lot of Miralax. That's it, go fill...


Alrigth i can't find his personal comment on the use of drug combination for SIBO but i can tell you the Pimentel recently said that Rifaximin works better alone,which seems to discredit his "combination logic" comments.


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## SpAsMaN* (May 11, 2002)

Flux,feel-free to comment!


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## bonniei (Jan 25, 2001)

first of all regarding hyperbiosis, flux seems to be thinking that SIBO is too much of one sort of bacteria growing, even good bacteria. I agree with that.Secondly flux has always saod to use the prokinetic after the course of antibiotic is completed. So I don't think that contradicts Pimentel saying that rifaximin is better alone.Resistance is a problem in the SI only because the resistant bacteria grow and multip;y flux says that _after_ the course of a/b the prokinetic keeps the bacteria, good and bad, from sticking to the walls and growing back again in the SI. . So resistance is not an issue. The problem that he sees with you is he seemed to think your problem was in the colon and hence ab can cause resistance since erythromycin only affects the MMCs in the small intestine and not motility of the colon. but Miralax in comboimation with a/b might help as Miralax flushes out all the bacteria specially bad bacteria in the colon. So if the problem due to resistance is bacteria growing anf multiply, regularly using Miralax will help. Or probiotics as they may crowd out the resistant bacteria.


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## SpAsMaN* (May 11, 2002)

> quote:erythromycin only affects the MMCs in the small intestine and not motility of the colon.










As for the MMC,i still think it is the term for motility in the Small B.Slow MMC=C of the small B.


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## bonniei (Jan 25, 2001)

It is unclear from this article that the whole gut transt has not been reduced due to the Phase III. It says nothing of colonic motility as far as I can tell. How are you oncluding that colonic motility has been affected?


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## SpAsMaN* (May 11, 2002)

I don't know if it really matter Bonnei.The body is an ensemble.The bowel motility is a sinusoidal wave that drives the small and the big intestine.As long as it moves the stuff gently,i will be


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## bonniei (Jan 25, 2001)

Oh now that you are wrong it doesn't matter anymore? LOL-LOL-LOL!


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## SpAsMaN* (May 11, 2002)




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## SpAsMaN* (May 11, 2002)

See math science also correlate to motility.I have use sinusoidal for an easier understanding.


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## bonniei (Jan 25, 2001)

LOL=LOL=LOL. I don't think the sinusoidal is helping but


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## cat crazy (Jan 28, 2002)

bonniei.Where can you buy Vivonex.Spas. I love your graemlins. Where do you get them from?


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## SpAsMaN* (May 11, 2002)

Actually,they call it the sinusoidal oscillations: http://www.blackwell-synergy.com/doi/abs/1...82.2004.00601.x


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## SpAsMaN* (May 11, 2002)

Mostly Yelims.comCall your local Novartis representative for a sample of Vivonex.


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## cat crazy (Jan 28, 2002)

Just finishing a 10 day course of rifaxmine tomorrow. Not sure yet if this has helped with symptoms of d, but has reduced the huge bloated tummy a lot, tummy looks much flater and pants fit better around the waist. Will wait a few more days after end of a/b course to see any difference in the d. I think the jury is still out on rifaxmine.


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## bonniei (Jan 25, 2001)

hanna keep us updated. spasman what did you learn from the sinusoidal oscillations?


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## SpAsMaN* (May 11, 2002)

Bonnie,it is the term to describe the peristaltic movement.There is also research to provide stools movement by microprocessor.Microprocessor controlled movement of solid colonic content using sequential neural electrical stimulation:http://gut.bmjjournals.com/cgi/content/full/50/4/475 OH my!I just receive Erythromycin,what should i do with it?


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## bonniei (Jan 25, 2001)

Only the peristaltic movements in the colon but. Not from the small intestine onwards.


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## SpAsMaN* (May 11, 2002)

I have receive Erythromycin,2 bottles of 500mg pills.I think that will last a long time since i should take very low dose.


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## bonniei (Jan 25, 2001)

I can't advice you what to do. Ask your doc. You might sue me. But you need to find out what they mean by a low dose. I am sure that the info is somewhere on the web. In fact I remember posting it. I don't remember what it said.


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## bonniei (Jan 25, 2001)

This was what was on Pimentel's site.dose -erythromycin (50 mg/day to 2000 mg/day in divided doses orally or I.V. in divided doses. So it seems to me a low dose would be 50 mg/day.


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## SpAsMaN* (May 11, 2002)

I have open a pill and took a little bit of the powder.I think it's powerful.That's my first impression.I always start with a tiny dose as a test since i'm sensitive.


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## bonniei (Jan 25, 2001)

I just don't approve of you doing the things way you do. Do you know if the powder is equally distributed.? Also you will be taking unequal doses from day to day since you are not measuring it. You will build up resistance to it this way. I just don't approve of it at all. But who am I to approve or disapprove?


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## SpAsMaN* (May 11, 2002)

I do a test for now.I don't know if i will go on.I know a girl that his doctor prescribe to her Erythro for the rest of her life against C.So if resistance is a problem they are not aware of it?


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## bonniei (Jan 25, 2001)

No giving unequal doses from day to day builds up resistance in my thinkin. Because some days you are killing more than on others and the days you don't kill them they adapt to the medication and resistant strains are formed. Atleast I would be worried about it. You can do as you please. It is your body. But I can't stand by and not say something while you are running all these dangerous experiments. Ok I will butt out now.


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## SpAsMaN* (May 11, 2002)

Anyway i drop,i have eye ache.Pimentel told me that if Cefuroxime has works in the past then it could be a good treament.But i don't think it will be realistic to use it forever.


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