# Pimentel - Rifaximin Questions



## hercules (Sep 12, 2009)

Hi all,First of all, I have "PI-SIBO-IBS-D" and have had it for about three years now. It started from food poisoning and I've been sick ever since. I've done all the tests, tried lots of diets, done extensive trials on a number of probiotics to very little avail (but nowhere near exhausted this avenue), have tried natural/herbal detoxes/remedies etc (didn't fix it) and have had complete but temporary successes on two separate occasions with AB's and natural antibacterials respectively. As a result, I'm pretty certain my problem is PI-SIBO-IBS-D and nothing else. Having said that, I'm planning on trying the Pimentel/Rifaximin protocol for the first time in a few weeks time and have a couple questions that I'm hoping I might be able to get some help with. These are:1.	Why does the length and degree of Pimentel AB treatments vary so much? (ie. effectiveness ranges from little or no improvements through to complete cures, and durations range from 1 day through to indefinite!?). Also, why is the return of sibo in this particular treatment so gradual. For example, stories suggest sibo very slowly returns over a period of months until it gets so bad that another course of ab's or Vivonex is required&#8230;whereas in my two brief successes in killing my sibo bugs, the sibo was back full blown within 24-48 hours of the onset of the very first hints of symptoms!? [and that's about how long it took to kill them too]. I'm thinking it's just a case of non-absorbable Rifaximin remaining in the system for different lengths of time for different people (ie. diets, lifestyles etc), and hence, traces of sibo bacteria gradually increase in numbers as Rifaximin residues are slowly flushed out/depleted from different areas throughout the small intestines? 2.	It was reported by one user on this website that taking probiotics while on and/or after the pimentel rifaximin regime was actually detrimental and prevented successful sibo eradication. Has anyone else had this experience? Is it possible that while offending sibo bacteria are being killed and flushed out (and producing larger amounts of toxins during this process making intestinal walls more inflamed) that introduced beneficial bacteria are establishing themselves on these raw walls preventing/slowing wall recovery (including a protective mucosal layer), and hence, allowing traces of the original offending bacteria to regain a foothold before complete eradication and complete recovery of intestinal walls&#8230;therefore, prolonging the sibo? What could be happening here? Should probiotics be used as part of treatment or not?3. Also, the pimentel book advises that the Vivonex approach seems to be more successful than the AB approach, where the overall population kill seems to be more complete. If starving the sibo bacteria works so well, why shouldn't poisoning them with ab's work just as well? Is it possible that Rifaximin being non-absorbable cannot penetrate intestinal walls to the depth required to kill any bacetria that might be embeded within? Any ideas? Could this warrant the use of a wider acting general ab such as Ciproflaxin to kill everything everywhere?4.	Finally, it's now suspected that one of the roles of the humble appendix is to store a small quantity of the right mix of your own personal blend of naturally occurring beneficial bacteria, which is used at times like food poisoning incidents where everything is discharged in a hurry, hence, allowing that "original" culture to re-establish itself in the large bowel immediately afterwards before any harmful foreign variants can. This makes sense to me - it would nicely compliment a digestive system that has low bacteria numbers in the small intestine by design (ie. charge the large bowel only, and not the whole digestive tract as is the case when ingesting probiotics). Any experts on this one?I know these questions are a bit out there but was hoping the answers might be within this group. And if not, I'm hoping it won't hurt to throw such ideas around amongst ourselves and hopefully together formulate a better hypothesis of what's going on&#8230;cause three years later I'm still dazzled.


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