# Rifaximin + Saccharomyces boulardii?



## zickzack

I want to combine Rifaximin with VSL#3 (like many others).Question:Is it reasonable to use Saccharomyces boulardii to prevent pseudomembranous colitis while taking rifaximin? Or could it interfere with the probiotics that are supposed to settle? What do you think?


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## 18704

I'd be assuming you'd be taking the VSL#3 *after* you finish up the Rifaximin doses. If you take the Rifaximin with the VSL#3 it will kill of the VSL#3 bacteria. Rifaximin will not discriminate between the good bacteria and the bad ones, it kills all of them.Saccharomyces boulardii (Florastor brand here in the US) is a yeast based probiotic. You *can* take Saccharomyces boulardii along with any antibiotic because the antibiotics only affect bacteria...since Saccharomyces boulardii is yeast, and not bacteria, they will survive through the antibiotic treatment. This is why Saccharomyces boulardii is usually always prescribed along with the antibiotics for people that are battling c-diff. Saccharomyces boulardii would not interfere at all with any other bacterial-based probiotic, they tend to complement each other. Another thing is that many bacterial probiotics tend to cause some gas but Saccharomyces boulardii tends to help get rid of gas...again balancing each other out.I would hold off on the VSL#3 though until you finish up the Rifaximin treatment as taking it during the treatment will be like throwing away all the good money VSL#3 will cost you...it's quite expensive.


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## zickzack

Thanks for your answer!


midnight1 said:


> Saccharomyces boulardii (Florastor brand here in the US) is a yeast based probiotic. You *can* take Saccharomyces boulardii along with any antibiotic because the antibiotics only affect bacteria...since Saccharomyces boulardii is yeast, and not bacteria, they will survive through the antibiotic treatment. This is why Saccharomyces boulardii is usually always prescribed along with the antibiotics for people that are battling c-diff. Saccharomyces boulardii would not interfere at all with any other bacterial-based probiotic, they tend to complement each other. Another thing is that many bacterial probiotics tend to cause some gas but Saccharomyces boulardii tends to help get rid of gas...again balancing each other out.


Ok thanks, then I will try this out while taking Rifaximin. I assume that another positive side effect of saccharomyces boulardii should be the prevention of candida.


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## 18704

That's very interesting, I will have to read the study further and thank you so much for uploading it. The reason I mentioned the above is that I visit the c-diff forum quite a bit, and from the users there, most are told to take the Saccharomyces boulardii yeast probiotic with their antibiotics and start the bacterial probiotics after they're done with the treatment. The 3 antibiotics usually prescribed for c-diff are Flagyl, Vancomycin and Rifaximin. Usually they take Flagyl first, after 2 rounds if the c-diff continues then they are placed on Vancomycin. If the relapses continue then the Rifaximin is usually added as a secondary antibiotic while still taking the Vancomycin for severely resistant cases of c-diff. The majority of them state that throughout the treatment the Saccharomyces boulardii is the only probiotic recommended because the bacterial ones would not survive.I have never had c-diff nor have I taken Rifaximin so I can't speak first hand. I do take Saccharomyces boulardii twice a day for IBS-D, it's excellent and I've have had great success with it.


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## 18704

I read the study...I have to admit I'm a bit tired though (6:16 AM here and I still have not gone to sleep for the night) and will have to go over it again tomorrow.Right below the quote you shared above, under the same 'Discussion' header it says:


> It has a broad spectrum antibiotic efficacy against anaerobic intestinal bacteria, such as bacteroides, lactobacilli and clostridia, all frequently involved in metabolic alterations of SIBO patients.[9,19]


Don't know, but the first quote and this one seem to contradict each other. How can Neomycin and Rifaximin "not eradicate physiologically desiderable lactobacilli"....but then also be "efficient against anaerobic intestinal bacteria, such as bacteroides, lactobacilli and clostridia, all frequently involved in metabolic alterations of SIBO patients."


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## cynthia

Why are neomycin and rifaximin prescribed together (as opposed to rifamaxin alone)? I've seen that combo discussed here before.Good to know about the saccharomyces boulardii being the only probiotic that should be used during a course of antibiotic. I have read that before but never understood, until now, why.I thought I read that rifamaxin alone was not thought to promote intestinal candida. But that actually doesn't really make sense - does it? It seems like any antibiotic going through the digestive tract will be killing off bacteria along the way, and that good bacteria should be consumed after completing the rifaximin. Right?


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## 18704

cynthia said:


> Why are neomycin and rifaximin prescribed together (as opposed to rifamaxin alone)? I've seen that combo discussed here before.


I am assuming that being prescribed the 2 at the same time would be the same as in c-diff infections where they prescribe the Vancomycin along with the Rifaximin in severe cases. It would be like a double punch to knock out the most strains of bad bacteria as possible. I am not a Doctor so this is just something that would make sense to me as to why Drs. may do this.


> Good to know about the saccharomyces boulardii being the only probiotic that should be used during a course of antibiotic. I have read that before but never understood, until now, why.





> I thought I read that rifamaxin alone was not thought to promote intestinal candida. But that actually doesn't really make sense - does it? It seems like any antibiotic going through the digestive tract will be killing off bacteria along the way, and that good bacteria should be consumed after completing the rifaximin. Right?


You are referring to Candidiasis, correct? Rifaximin should have no effect on Candidiasis that may be present because Candidiasis is a pathogenic yeast and not a bacteria. Common sense would dictate to me that it could exasperate Candidiasis as it would be clearing out any competing bacteria present giving Candidiasis the clear and sole advantage to all the space and nutrition it would need to survive. So I feel this would be another strong point for taking Saccharomyces boulardii along with the Rifaximin. By supplementing with large amounts of Saccharomyces boulardii it would then be present in greater numbers than the Candidiasis and rob the nutrition and space that the Candidiasis would need to survive. Again, I'm not a Dr. and just thinking this though from all the study documentation I have read in regards to the actions of how Saccharomyces boulardii populates and works in the GI tract.To kill of Candidiasis you would need to take an anti-fungal, not an antibiotic. Diflucan or Nizoral are two anti-fungals that come to mind. But if these are taken they would also kill off Saccharomyces boulardii. Even though Saccharomyces boulardii is a non-pathogenic yeast, it would still be affected by anti-fungals. This is why I have a difficult time understanding just how Rifaximin or Neomycin antibiotics can truly discriminate between pathogenic and non-pathogenic bacterias. This is certainly not the case with anti-fungals as they will kill off both good and bad yeast present.


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## cynthia

midnight1 said:


> I am assuming that being prescribed the 2 at the same time would be the same as in c-diff infections where they prescribe the Vancomycin along with the Rifaximin in severe cases. It would be like a double punch to knock out the most strains of bad bacteria as possible. I am not a Doctor so this is just something that would make sense to me as to why Drs. may do this.


Is it something to do with aerobic and anerobic bacteria? Does each antibiotic kill only one type of bacteria?


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## cynthia

midnight1 said:


> Rifaximin should have no effect on Candidiasis that may be present because Candidiasis is a pathogenic yeast and not a bacteria. Common sense would dictate to me that it could exasperate Candidiasis as it would be clearing out any competing bacteria present giving Candidiasis the clear and sole advantage to all the space and nutrition it would need to survive. So I feel this would be another strong point for taking Saccharomyces boulardii along with the Rifaximin. By supplementing with large amounts of Saccharomyces boulardii it would then be present in greater numbers than the Candidiasis and rob the nutrition and space that the Candidiasis would need to survive. Again, I'm not a Dr. and just thinking this though from all the study documentation I have read in regards to the actions of how Saccharomyces boulardii populates and works in the GI track.


Just trying to follow this (on only 3 1/2 hours sleep last night). You're saying that rifaximin will be killing off bacteria throughout intestines thereby giving bad bacteria to grow, creating a yeast overgrowth. Right? Then, after taking rifaximin, along with saccharomyces boulardii, it might be a good idea to flood the digestive tract with probiotics??


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## 18704

cynthia said:


> Just trying to follow this (on only 3 1/2 hours sleep last night). You're saying that rifaximin will be killing off bacteria throughout intestines thereby giving bad bacteria to grow, creating a yeast overgrowth. Right? Then, after taking rifaximin, along with saccharomyces boulardii, it might be a good idea to flood the digestive tract with probiotics??


Again, it's only my assumption that Rifaximin could very well kill off the bad bacteria in our GI tract. It would certainly not 'cause' a yeast overgrowth unless the Candidiasis is already present. If this is the case then the Candidiasis could flourish and gain strength since it would have no resistance from any other good or bad bacterias in there helping to keep everything in working order.Make sure you distinguish bacteria from yeast, they are two totally different 'bugs' that live in our GI tract. I do believe that taking Rifaximin along with Saccharomyces boulardii would be the best way to do the initial antibiotic treatment. Once that's over then flooding the GI tract with bacterial-based probiotics *plus* continuing to take the Florastor would help rebuild your flora with beneficial bacteria and yeast


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## cynthia

midnight1 said:


> Again, it's only my assumption that Rifaximin could very well kill off the bad bacteria in our GI track. It would certainly not 'cause' a yeast overgrowth unless the Candidiasis is already present.


Isn't it overuse of antibiotics that often results in candida in the first place?


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## 18704

Don't think so. Antibiotic overuse could contribute to Candidiasis overgrowth but it wouldn't be the cause of it. The Candidiasis has to be established there in the first place and when the antibiotic kills off all the other existing bacteria the Candidiasis becomes opportunistic and takes over. This is similar to a c-diff infection, the c-diff is already present and existing. When the antibiotic is taken all other competing pathogenic and non-pathogenic bacteria are killed and the GI flora becomes unbalanced. C-diff being very hardy, and also the fact that it forms spores that can stick around what seems like forever, then proliferates and takes control of the environment. Candidiasis is very prevalent in immune suppressed persons such as people receiving chemotherapy for Cancer, AIDS patients or transplant patients. Their Candidiasis is not 'caused' because they are taking antibiotics, but because they're immunocompromised, their systems can't keep the Candidiasis in check as it should do in a person who's immunity is normal. So unless you have a severely compromised immune system you should not have Candidiasis overgrowth. That's why it's referred to as an opportunistic infection. It needs a reason to proliferate but it's there already in the system previous to the antibiotics use.You refer to Candidiasis (Candida Albicans) as Candida. Please do not confuse the true medical condition of Candidiasis to the 'Candida' that many snake oil hawkers online talk about when they are trying to sell you some supplement or other to help 'cure' it. According to these guys anyone that has an itchy scalp, is depressed, has a low libido, shoulder pains, restless legs even down to a single toenail fungus, and practically every other general symptom in between, 'is suffering from Candida overgrowth' and needs to buy their supplements. Candida is actually not even recognized by the medical community. Systemic fungal infections (fungemia caused by the Candida Albicans yeast) do exist but they are generally seen only in immune compromised individuals. Anti-fungals, such as Diflucan or Nizoral, are the only way to eradicate Candidiasis overgrowth. Supplementing with Oil of Oregano, Grapefruit Seed Extract, and any other 'quack cures' supplements just won't cut it no matter what the snake oil salesmen promises you or how many testimonials they may have at their websites to try and prove what they 'preach'. They don't have a medical leg to stand on and can't prove through any clinical observations, competent medical testing or trials that their 'treatments' are effective. Candida Albicans normally exists in the gut flora of 80% of the human population with no harmful effects, it's only when there's an overgrowth in a person who's immunity is compromised that it can proliferate and cause serious problems.


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## cynthia

Is Florastor any more effective if taken apart from food?


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## 18704

cynthia said:


> Is Florastor any more effective if taken apart from food?


Yes it is. The recommendation is that you take 1 capsule twice a day on an empty stomach with room temperature water. This is how I have taken it for almost 5 months now.


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## cynthia

midnight,I'm not sure if you mentioned before or not - have you ever taken antibiotics with florastor? If so (or even if not you many know) - will taking the florastor at the same time as the rifaxamin diminish the effectiveness of either? Thanks for all the info.C


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## 18704

cynthia said:


> midnight,I'm not sure if you mentioned before or not - have you ever taken antibiotics with florastor? If so (or even if not you many know) - will taking the florastor at the same time as the rifaxamin diminish the effectiveness of either? Thanks for all the info.C


I have not taken antibiotics in the 5 months (yep, 5 months already and still feeling great!) I have been taking Florastor. I certainly would not take any antibiotic without taking Florastor along with it, especially the horror stories I have read about on the c-diff forums. I would suggest spacing them out a bit from each other so both have a chance to act well on their own. Maybe a timing of one of these two hours before or two hours after the other would be a good idea Cynthia.


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## eric

FYI on Candidacandida is normally found in the bowel. Real Candidiasis which is a "Systemic Candidiasis are "systemic infections" They find this in people with aids or cancer or highly compromised immune systems. You would feel very sick and they can see it and test for it in the blood.As for candidaWhy is there candida in the bowel in the first place in humans?""Candida albicans, and other strains of Candida are yeast that normally inhabits our digestive system: the mouth, throat, intestines and genitourinary tract. Candida is a normal part of the bowel flora (the organisms that naturally live inside our intestines, and are not parasitic). It has many functions inside our digestive tract, one of them to recognize and destroy harmful bacteria. Without Candida albicans in our intestines we would be defenseless against many pathogen bacteria. Healthy person can have a millions of Candida albicans."Postgrad Med J. 1992 Jun;68(800):453-4. Related Articles, Links Comment in: Postgrad Med J. 1993 Jan;69(807):80.The role of faecal Candida albicans in the pathogenesis of food-intolerant irritable bowel syndrome.Middleton SJ, Coley A, Hunter JO.Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, UK.Candida albicans was sought in stool samples from 38 patients with irritable bowel syndrome and 20 healthy controls. In only three patients with irritable bowel syndrome was C. albicans discovered and these patients had either recently received antibiotics or the stool sample had been delayed more than 24 hours in transit. C. albicans was isolated from none of the control stool samples. We conclude that C. albicans is not involved in the aetiology of the irritable bowel syndrome.PMID: 1437926 The Australasian Society of Clinical Immunology and Allergy has issued this paper on Allergy testing and treatments."ASCIA Position Statement: Unorthodox Techniques for the Diagnosis and Treatment of Allergy, Asthma and Immune Disorders Dr Raymond J. Mullins on behalf of the Education Committee, ASCIA October 2004 "INAPPROPRIATE TESTINGChronic CandidiasisUse: Treatment of a variety of ailments including allergy, irritable bowel, food allergy and intolerance, autoimmunity, arthritis and psychological conditions. Method: This approach is based on the concept that imbalance of gut flora results in overgrowth of Candida albicans within the gut. Release of fungal toxins results in a variety of symptoms including fatigue, arthritis, irritable bowel, food intolerance as well as psychological symptoms. These toxins weaken the immune system, predisposing to further symptoms from ingested foods and toxins. Treatment centres on dietary supplements, administration of antifungal drugs such as nystatin, and restriction of "Candida friendly" foods such as those containing sugars, yeast or molds. Evidence: Candida is a normal gut organism, and immune responses (antibodies, cell mediated responses) to this organism are both expected and observed in healthy controls as well as those allegedly suffering from this condition. There is no evidence of overgrowth of Candida or altered immune responses to this organism in patients complaining of this syndrome. There is neither a scientific rationale nor published evidence that elimination of Candida with diets or anti-fungal therapy is useful for management."http://www.allergy.org.au/pospapers/unorthodox.htm About chronic candidiasisAn overgrowth in the gastrointestinal tract of the usually benign yeast (or fungus) Candida albicans has been suggested as the origin of a complex medical syndrome called chronic candidiasis, or yeast syndrome.1 2Purported symptoms of chronic candidiasis are fatigue, allergies, immune system malfunction, depression, chemical sensitivities, and digestive disturbances.3 4 Conventional medical authorities do acknowledge the existence of a chronic Candida infection that affects the whole body and is sometimes called â€œchronic disseminated candidiasis.â€œ5 However, this universally accepted disease is both uncommon, and decidedly more narrow in scope, than the so-called Yeast Syndromeâ€"a condition believed by some to be quite common, particularly in people with a history of long-term antibiotic use. The term â€œchronic candidiasisâ€ as used in this article refers to the as yet unproven Yeast Syndrome."Real Candidiasis which is a "Systemic Candidiasis are "systemic infections"http://www.emedicine.com/emerg/topic76.htmIBS is NOT an infectious disease.I have talked to quite a few lab people who do colonoscopies about this and they have never seen "yeast syndrome" but have seen "disseminated candidiasis" in aids patients and cancer patients where the immune system was highly compormised.When they have looked at gut flora in the bowel in IBS.Gut Bacteria and Irritable Bowel Syndrome By: Eamonn, M. M. Quigley M.D., Alimentary Pharmabiotic Centre, University College Cork, Cork, IrelandBacteria are present in the normal gut (intestines) and in large numbers the lower parts of the intestine. These "normal" bacteria have important functions in life. A variety of factors may disturb the mutually beneficial relationship between the flora and its host, and disease may result. The possibility that gut bacteria could have a role in irritable bowel syndrome (IBS) may surprise some; there is indeed, now quite substantial evidence to support the idea that disturbances in the bacteria that populate the intestine may have a role in at least some patients with IBS. This article presents a discussion of the possible role of bacteria in IBS and various treatment approaches."Do bacteria play a role in IBS?The possibility that gut bacteria could have a role Irritable Bowel Syndrome (IBS) may surprize some; there is indeed, now quite substantial evidence to support the idea that distrubances in the bacteria that populate the intestines may have a role in at least some patients with IBS. What is this evidence? It can be summarized as follows:1. surveys which found that antibiotic use, well known to distrub flora, may predispose individuals to IBS.2. The observation that some individuals may develop IBS suddenly, and for the first time, following an episode of stomach or intestinal infection (gatroenteritis) caused by a bacterial infection. (Note:this is post infectious IBS, after resolution of the intial infection.)3. recent evidence that a very low level of inflammation may be present in the bowel wall of some IBS patients, a degree of inflammation that could well have resulted from abnormal interactions with bacteria in the gut.4. The Suggestion that IBS maybe Associated with the abnormal presents, , in the small intestines, of types and numbers; a condition termed small bacterial overgrowth (SIBO)5. Accumaliting evidence to indicate that altering the bacteria in the gut, by antibiotics or probiotics, may improve symptoms in IBS.For some time, various studies have suggested the presence of changes in the kind of colonic flora in IBS patients. The most consistent finding is a relative decrease in the population of one species of 'good' bacteria, bifidobacteria.However, the methods employed in these studies have been subject to question and other studies have not always reproduced these finding. Nevertheless, these changes in the flora, maybe primary or secondary, could lead to the increase of bacterial species that produce more gas and other products of their metabolism. These could CONTRIBUTE to symptoms such as gas, bloating and diarrhea.""We still don't know the exact role bacteria has in IBS. More research is needed."http://www.aboutibs.org/Publications/currentParticipate.htmlThe above article in not the full article and there is important information in it in regards to it. You can get it from the IFFGD but it costs four bucks. Of course that supports IBS research and awareness. But its a very good article though.


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## zickzack

midnight1 said:


> Don't know, but the first quote and this one seem to contradict each other. How can Neomycin and Rifaximin "not eradicate physiologically desiderable lactobacilli"....but then also be "efficient against anaerobic intestinal bacteria, such as bacteroides, lactobacilli and clostridia, all frequently involved in metabolic alterations of SIBO patients."


The two statement are not necessarily contrary: It could be possible that Rifaximin eradicates *some* kinds of lactobacilli, but some (or *the*) "physiologically desiderable" ones are resistant to it!


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## CanadianGuy

I know I'm digging up an old thread here but this is exactly what I've been looking for.

My doctor prescribed 10 day courses of rifaximin 550mg 2x per day and nystatin antifungal with it. This is a protocol written about by Dr. Mark Hyman. Should I take the boullardii after the 10 day course of both drugs are completed?


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