# Flagyl and probiotics



## Overit

Hi,I just started on Flagyl today to treat my SIBO. Should I take probiotics at the same time or wait until I have finished my course? I would have thought the Flagyl would wipe out the effects of the probiotics is all.... what do people think? Thanks


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## Kathleen M.

I'm not sure if there is a good list of which antibiotics actually kill which probiotics. Even broad spectrum antibiotics don't kill everyone.It won't hurt to take them together (other than you may kill of more than usual) and if some survive the antibiotic that give you a head start on deciding what bacteria recolonize in there rather than just leaving it all up to chance.


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## Moises

Overit,How do you know you have SIBO?Please let us know how the Flagyl is working for you.Are you taking Flagyl alone, or in combination with other drugs?


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## Overit

Hi MoisesI did hydrogen breath tests and they all came up positive for Lactose Intolerance, Fructose Malabsorption and SIBO. The "trifecta" as they called it. It's day 2 on Flagyl and I am feeling better, but then again i have been really unwell with daily problems for so long now - bloating, gas, constipation, abdominal pain - so any relief, however minor, is better than nothing! I am really frustrated. Going to gastroenterologist next Monday - hopefully they can find out what is wrong with me. I am following a strict diet, taking probiotics, doing all the right things, but still I have problems.... Wish me luck!


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## faze action

My "gut" (ha ha) response to your original question would be to wait until after the Flagyl to start the pro-Bs. I actually just finished a course of ABs to erradicate SIBO, and my doctor wanted me to wait until after the ABs to start on the probiotics. I don't think it would cause any problems to do them both at once, but you might lose some of the benefit of the probiotics due to the antimicrobial action of the ABs. For me, I'd rather wait, especially considering how expensive Align (probiotic) is... seems like potentially killing off some of them with the ABs is like throwing money down the drain.


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## Patman75

Take probiotics at least 2 hours after antiboitics. Ot they will be wiped out and you will be wasting all those expensive probiotics


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## Overit

I went to a seminar tonight (Dr Sue Shepherd in Australia who has written extensively about fructose malabsorption) and she said NO prebiotics or probiotics at all if you have fructose malabsorption, at least not in the first 3 months. Problem is bacteria, so you don't need more! Go figure.


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## IanRamsay

overitHiI have never heard of that. no probiotics with fruc mal? very strange indeed. cheersIan


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## Moises

Overit,What happened to you? Did the Flagyl help?


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## Overit

Hi MoisesI was good for a while, then bang flared up again. On my second course of Flagyl now. Failing that my gastroentrologist said he might be able to get some Rifamaxin but it's a convuluted process to get it here in Australia. I haven't been taking any probiotics and to be honest, i haven't missed them or noticed any difference with or without them. I just wish i could get rid of this SIBO once and for all!


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## Moises

Overit said:


> Hi MoisesI was good for a while, then bang flared up again. On my second course of Flagyl now. Failing that my gastroentrologist said he might be able to get some Rifamaxin but it's a convuluted process to get it here in Australia. I haven't been taking any probiotics and to be honest, i haven't missed them or noticed any difference with or without them. I just wish i could get rid of this SIBO once and for all!


Overit,I wish you the best. I am actually on my 4th day of Flagyl (500 mg 3x/day) right now. I am simultaneously taking Cipro (500 mg 2x/day). Rifaximin did nothing for me. So far, Flagyl and Cipro have only given me lots of watery diarrhea. If you buy into Pimentel's SIBO theory, then, if Flagyl works for you, you should follow it with erythromycin before bed each night at 50 mg. Since it's impossible in the US to get 50 mg of erythromycin, I've been told that it's OK to get erythromycin 250 mg and cut the tablet into quarters. If I have any sign that the antibiotics are helping me, I will try the erythromycin afterwards.I see that Flagyl helped you by day 2. I guess that means the fact that I am not feeling better on day 4 is a bad sign for me.


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## jmc09

I'm no expert but if certain ABs don't work maybe it's because you have got a different type of bacteria to what the ABs are used for?Maybe it's just a case of finding an AB that's the right one for you.There are a few different ones out there I'm told.Maybe even you haven't found the right combination yet.Good luck.


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## Overit

Hi allI took a second course of Flagyl and i am 90-95% better since the new year. It is such a relief! I advise anyone who suspects bacterial overgrowth to get properly tested for lactose intolerance, fructose malabsorption and SIBO. I was diagnosed with all 3. I am on a very strict diet and am seeing the effects after a few months. With the diet, the antibiotics, and a positive outlook I am almost back to normal!! And no probiotics needed at all. Anyway that is my story. I keep my fingers crossed every day that I remain healthy


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## jmc09

Overit,were you originally diagnosed with IBS before SIBO?


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## Overit

Things started going wrong about a year ago. My doc ran lots of blood tests (all negative), I did a colonoscopy (all clear) and she also referred me to the breath tests for SIBO and sugar intolerances. It took some time for me to have those tests, so yes, in that time i was diagnosed with "IBS". I suppose I have been lucky that I have discovered a "cause" and so can treat my condition properly. I hope it's as simple as that. THat said, I've also had endometriosis (which has subsequently been treated), so lots of things have been going wrong downstairs. Who knows? All I know is that i am feeling significantly better being on the diet and also after 2 courses of the antibiotics. I just hope/pray that this will last!!


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## Moises

Overit,Thanks for the update. I am glad you are so much improved.


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## King Of The Small Room

Overit, just out of interest, how long, and at what dosage did you have to take Flagyl for? And won't the relief be temporary, or have you been told there is a chance your improvement could be permanent?Incidentally, I first became aware of antibiotics as a possible treatment for certain types of IBS after noticing a big improvement in my symptoms after taking metronidazole (flagyl) for an unrelated problem a good few years ago, though because it was only a one week course, the improvement didn't last much longer than the course itself. Maybe a week after I'd stopped taking them?Because of this, I have also tried two other antibiotics which had no effect, though I can't remember which ones they were, though mycin was possibly one?Finally, I also tried Rifaximin, which is difficult and expensive for us to get hold of here in the UK too, but it gave me 3 months of a good level of relief after a 10 day course.To my amazement, I'm now having similar levels of improvement through eating two tubs a day of Activia yoghurt.I really didn't see that coming and can't believe the improvement will be maintained after so many other treatments have failed over the years. I fully intend to enjoy it while it lasts though.Incidentally, the only two types of antibiotics that have ever given me thrush as a nasty reminder of their existence, were the same two that gave me the relief from the SIBO/IBS symptoms, Flagyl and Rifaximin.The relief was obviously welcome, the thrush most definitely wasn't!


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## MomOfIbsTeen

Hi Overit,Good to hear about your recovery! My 18-year old daughter tested positive for SIBO last year after a variety of other tests that were all negative/normal. Her GI doctor prescribed Xifaxan (Rifaximin) a year ago March 2009. She improved, then had a relapse in November 2009 and went back on Xifaxan. She just had another relapse last week. All 3 hydrogen breath tests were positive for SIBO.I keep wondering why the bacterial overgrowth continues to come back. One possible cause is birth control pills, which her GYN doctor prescribed because of her irregular periods (too frequent, very heavy flow, bad cramps). She has been taking YAZ and the IBS symptoms started 4 months after starting this birth control pill. I just found another thread on this forum and several women have attributed their IBS/GI problems to either Yaz or Yasmin.I am curious whether you have been taking any form of hormone pills or birth control pills, since you mentioned you had Endometriosis. And if so, how long you took BCPs before you had GI problems.We thought that my daughter was cured after the first round of antibiotics, but she has had 2 relapses. We tried Cipro which did nothing. She also tried Neomycin but after 3 days, the nausea was too overpowering so she stopped taking that. After each course of Xifaxan, she took probiotics. Now I'm wondering if she should go off the birth control pills completely and put up with the GYN symptoms rather than the IBS-SIBO symptoms. Did you experience any side effects from Flagyl? I am also wondering what your dosage was for Flagyl.Thanks for your updates. I hope you are cured for good!


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## Hester

I think your theory is possible. I have also found that SIBO can come back due to lack of stomach acid and antacid use as well as taking probotics. Mine came back four times and I believe I traced it back to proton pump inhibitors twice and then to probotics. Each time ABs calmed it down. However, now I seem to have a very sensitive gut and have to really watch what I eat. Soft, blended, raw, unprocessed or cooked and low fat foods seem to be best as well as fish. Fried foods, coffee, alcohol, dairy are all on the no-way list.


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## Overit

I was on 400mg of Flagyl 3 times daily for 2 weeks. x 2 courses over a couple of months. I had immediate improvement after the first course, but relapsed again after 3 weeks. Around that time, the endometriosis was treated (removed) and I have a Mirena Coil currently in which is working well (progestrone treatment). I have been on the fructose/lactose free diet for over 5 months now. Are people following this diet? This is a life-long thing. I think everyone is differnet of course, and of course there is concern that I will relapse again given these are common stories. My IBS problems started around the time my periods got worse (sorry boys!) - maybe there is a connection? With probitotics, I don't take them at all on the advice of my gastro-entrologist and dietician, they both advised that adding bacteria (whether 'good' or 'bad') was not wise given I had overgrowth. I acknowledge everyone is different and probiotics (including yogurt) would help people. BEcause I've done 3 things simulatenously (diet. antibiotics, treated the endo) i'm unsure what exactly has been the trigger for my improvement. Maybe it is all threeI was also tested for the gene that indicates predisposal to Celiac Disease. This was positive, although I do not currently have Celiac Disease. Whilst medically I am not intolerant to gluten, I do try to remain gluten free just to be on the safe side, and so far so good.I am not 100% back to normal, but b/c my improvement has been significant, I am not ready to take anything for granted, so I continue to follow the diet, and am careful about meal portions (i don't eat as much as I used to in one sitting) and not working as hard as I used to. I hope you all find a cure to this horrible condition. I hope & pray I remain OK - I am so relieved I have found a treatment that has worked, but I am not getting ahead of myself! Not yet at least....


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## jmc09

King,I wasn't aware Rifaximin was available in the UK?I am just starting a course of metronidazole(flagyl) for an unrelated problem 1 tablet,200mg 3 times a day.I'm hoping it helps as yours did!


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## King Of The Small Room

jmc09 said:


> King,I wasn't aware Rifaximin was available in the UK?


As far as I know, it has never been officially licenced to be available in the UK so it is hard to get hold of. But you can get it if you are prepared to pay.You'll need a private prescription for a start, then you'll have to make the pharmacist aware of where the suppliers are so he/she can get in touch with them to order it.There may be several suppliers but the one I'm aware of is called IDIS and is based in Weybridge, Surrey. Apparently they specialise in supplying drugs/medicines which aren't yet officially available here.At the moment, a two week course from this supplier would cost a total of just under £200, which would include a 50% mark up fee for a private prescription for the pharmacist who deals with it.So obviously trying others like Metronidazole first in the sensible thing to do.Don't get drunk while you're taking them though or you'll know about it (Metronidazole I mean.)


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## jmc09

Yes King my dentist related an alcohol related metronidazole incident when writing me the prescription.She said that she prescribed the drug a few years ago for a patient over the christmas period and he had every intention of doing so as he was visiting his mother in laws house for Christmas dinner.He avoided alcohol with the main meal and enjoyed a very nice dessert,Sherry Trifle!







I'm pretty certain you know the rest!


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## jmc09

King,as you are in the UK could you please tell me how and when you were diagnosed with SIBO?Thanks


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## King Of The Small Room

I suppose I've never been diagnosed with a 100% degree of certainty and I've never had the breath test.I'm a patient of Prof Whorwell at Withington hospital in Manchester who I see every 6 months.I mentioned earlier in this thread that I had a decent, but temporary level of improvement after taking Metronidazole for an unrelated problem a few years ago. This was to treat the helicobater pylori that they found in my gut after a gastroscopy, relevant biopsies and blood tests. This was in Liverpool where I live btw, and was independent of anything that was going on with the Prof in Manchester I told this to the Prof when I next saw him and he said it looked as if I had too much of the wrong type of bacteria in my small intestine. He never specifically mentioned SIBO by name, and at the time I'd never heard of it, the existence of this was something I only became aware of after discovering these forums.So he gave me a list of various antibiotics that were known to help this problem. The main one he mentioned was Rifaximin as this had produced the best results for most people in the US and the smaller numbers of people who had tried it eslewhere. Due to the cost, he suggested I try the others first, with Metronidazole as his 1st suggestion as I'd had the improvement in the past. For what I suppose were selfish reasons, I ignored this advice and tried the others first, as at the time, the recommended course lasted 1 month (I don't think this is the case now - 2 weeks maybe?) I didn't fancy this as I had a succession of family social functions, a nieces wedding, a Christening, a 21st birthday party and all these events would have involved drinking alcohol which you can't do with Metronidazole, not even in moderation which I was intending to do at these events. Yes, I have absolutely no will power!







So I first tried what I think was Neomycin, then after a decent sized gap another one which I can't recall the name of, (or vice versa) each with no improvement. Then I finally tried Rifaximin last summer and had about 3 months of a big improvement in my symptoms.On this basis it was decided during my next consultation with the Prof, that SIBO (which I had discovered the existence of by now thanks to these forums) was indeed the most likely source of my problems and we then talked about probiotics.I asked him which one he would recommend, but he wouldn't put his recommendation to any of them as he believes not enough research has been carried out, apart from Align. This however, would result in the same problem as in getting hold of the Rifaximin with it supposedly only being available from the US, ie excessive cost. So if I wanted to go through the long list of the many other probiotics 'till I eventually found one that works, then it would be my own personal choice.Then he finally added that the only other one which he considered to have been fully researched which was easily available in the UK, was Activia yoghurt.I had, and still have other tests to go through, and when they were over, I fully intended to go through the A - Z of probiotics 'till I hopefully found one that worked. In the meantime, I didn't think it would do any harm to try Activia yoghurt, albeit with absolutely no expectations of success.To my amazement, after eating the recommended 2 tubs per day, after about 10 or 11 days, I had an improvement which mirrored almost exactly the sort of improvement I had when on Rifaximin.So as far as I'm concerned, although I've never been told as an absolute fact that I've got SIBO, it does seem a fair bet bearing in mind the experiences I've had after taking the various things that are meant to help this condition.I haven't had a 100% improvement, but due to the other problems I have which are still being investigated, I wouldn't have expected to.However, after 17 years of severe problems, and remedy after remedy proving to be a load of b******s, any improvement is VERY welcome.Good luck!Regards,Ian.


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## jmc09

Ian,we are almost neighbours!I too have suffered for around about the same length of time with my condition as you seem to have.What I would give to have 3 months of relief that you had after trying Rifaximin,the UK really need to make it readily available on nhs prescription.It's a shame doctors are so reluctant to give us sufferers a better chance of managing our conditions.John


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## jmc09

Ian where you able to see Prof Whorwell on the NHS?Did you find him helpful and considerate rather than cold and uninterested?I dont live too far away so if I could see him or one of his team on NHS it would be great.


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## King Of The Small Room

I've PM'd you John.Didn't want to bore everyone with another long one.


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