# My second round of Xifaxin.



## 17908 (Oct 18, 2006)

So about 6 months after my first round of Xifaxin, I'm starting another 20 days of 1200 mg/day. The first round worked until about a month ago when symptoms definitely started coming back. They never got as bad as before the first round, but I wanted to get things stopped before they got too bad again.About 4 days into the Xifaxin, I'm already almost 100% normal. Last time it took about 14 or 15 days to feel nearly 100% normal. I can't believe the amazing difference I feel on this stuff. I feel like I did many years ago when I was normal and I didn't constantly worry about what foods would make me feel like ####. I just hope it completely kills the bacteria this time.


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## 21718 (Oct 30, 2006)

Hey npearce,That's so great that you have found a treatment that works for you! And that it's _repeatable_.What I'm curious is, if you were "cured" before, why did your symptoms come back? Does your doctor have an explanation for that? BTW, did you feel cured after your first round of Xifaxan? Or were you just partially better.Myself, I'm starting to doubt the whole SIBO theory.


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## 16226 (Apr 4, 2007)

Could someone tell me what Xifaxin is suppose to do? What type of GI disorder is it suppose to help?thanks


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## 17908 (Oct 18, 2006)

> quote:Originally posted by Savateur:Hey npearce,That's so great that you have found a treatment that works for you! And that it's _repeatable_.What I'm curious is, if you were "cured" before, why did your symptoms come back? Does your doctor have an explanation for that? BTW, did you feel cured after your first round of Xifaxan? Or were you just partially better.Myself, I'm starting to doubt the whole SIBO theory.


I didn't mean to imply that I was actually "cured". I would say the Xifaxan simply knocked back the symptoms by a good 90%. Over the 5 months that it took for them to return, the symptoms very gradually started coming back. The symptoms didn't come back nearly as strong as they were before the first round, but I didn't want to wait around for that either. I'd say I was only symptom free for a few days after the Xifaxan. If this is truly a bacterial infection, that is about all the time you'd have before bacteria starts to return.My doctor is simply following the recommendations in Pimental's book. So he is not expert on this type of treatment. He didn't have an explanation for why the symptoms returned.I'm hoping to have better luck this time, because I'm going to try erythromycin when I'm done. I'm also going to try a few different probiotics. I've tried quiet a few different ones in the past with no results.


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## 17908 (Oct 18, 2006)

> quote:Originally posted by mps23:Could someone tell me what Xifaxin is suppose to do? What type of GI disorder is it suppose to help?thanks


Xifaxan is an antibiotic that stays almost exclusively in the gut (most antibiotics get into the blood), and it is approved for treatment of traveller's diarhea. However, GI's have recently started using it to treat IBS/SIBO. It is still experimental, but it is getting some positive results. It is also being used with some success to treat Crohn's.


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## 21718 (Oct 30, 2006)

Thank you for the clarification on what the Xifaxan did and didn't do for you. That makes sense now.


> quote: If this is truly a bacterial infection, that is about all the time you'd have before bacteria starts to return.


 But if you truly got rid of the bacteria, why should they come back? To answer my own question, the definition of SIBO is that there are supposed to be bacteria in your body, but they've migrated to a place they don't belong and that's where the trouble comes from. Hmm.Is the erythromycin for maintenance?


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## 17908 (Oct 18, 2006)

Erythromycin is for maintenance, in place of the now-banned Zelnorm.You're probably right about SIBO being bacteria growth where it shouldn't be. I'm just not optimistic enough to think Xifaxin will totally wipe it out. There are too many cases of the bacteria eventually returning. Maybe it totally cures some people, though. My hope is that it just makes me feel significantly better. Then the erythromycin can hopefully slow the return down.


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## 21718 (Oct 30, 2006)

Then I wish you the best of luck with the Xifaxan _and_ Erythromycin.I was on erythromycin (to manage acne) when my post-infectious IBS began. I had been taking the erythromycin for ~3 years at that point. It had never caused me any GI trouble (and it _was_ helping my acne). But I think that, in my case, the long-term antibiotic was likely a factor in my getting IBS. I think it was a bad combination of altered gut bacteria + infection and maybe I was more susceptible because of that.I'm not telling you this story to scare you, I'm not quite sure what the message is myself. Maybe that long-term antibiotics are bad. Maybe that the same medication can sometimes help and sometimes hurt. Maybe that I was just unlucky!


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## eric (Jul 8, 1999)

A motility problem itself may cause sibo to begin with and then there is bacteria in the small bowel where its really not suppose to be.This explains it better from an expert.IT IS AN OVERSTATEMENT TO SAY THEY ARE "IRRITATING" SUBSTANCES AT LEAST IN THE SENSE OF BEING SOME TYPE OF TOXIN. THEY ARE NATURAL BYPRODUCTS OF DEGRADATION OF FOOD SUBSTANCES BY BACTERIA WHICH DON'T NORMALLY OCCUR IN THE SMALL BOWEL. SO WITH INCREASED BACTERIA IN THE SMALL BOWEL, THE BACTERIA ARE ABLE TO DIGEST SUGARS FOR EXAMPLE PRODUCING H2 AND CO2 FROM THE SUGARS WHICH ARE GASEOUS BUT WHICH ALSO HAVE OSMOTIC PROPERTIES, I.E. INCREASED PARTICLES THAT CAUSE SECRETION OF FLUID INTO THE BOWEL THUS CAUSING DIARRHEA. IT'S THE SAME PRINCIPLE AS USING NON ABSORBABLE SUGARS LIKE LACTULOSE OR SORBITAL TO TREAT CONSIPATION BY INCREASING FLUID IN THE BOWEL. IT'S JUST THAT WITHOUT BACTERIA IN THE SMALL BOWEL, IT DOESN'T HAPPEN AND THE FOOD SUBSTANCES GET ABSORBED. WITH INCREASED BACTERIA IT COMPETES FOR THE FOOD SUBSTANCES AND PRODUCES THE GAS AND DIARRHEA."*This means these are just in the wrong place and not specific or multiple pathogens?*CORRECT. HOWEVER, THERE IS GROWING INTEREST NOT IN THE AMOUNT OF BACTERIA BUT THE TYPE OF BACTERIA. CERTAIN BACTERIA CAN CAUSE SOME MILD INFLAMMATION OF THE BOWEL AND OTHERS PROTECT THE BOWEL FROM THAT POSSIBILITY. SO THERE IS "GOOD" AND "BAD" BACTERIA. POSSIBLY WHEN PEOPLE ARE TREATING PRESUMED SIBO (WHICH MIGHT NOT ACTUALLY BE HAPPENNING, BECAUSE THE TEST MAY BE INACCURATE) ANTIBIOTICS MAY HELP TO GET RID OF THE BAD BACTERIA AND THAT MAY BE WHY THEY ARE GETTING BETTER. THIS IS WHY SOME PEOPLE GET BETTER AFTER ANTIBIOTIC TREATMENT. BUT IT CAN ALSO GO THE OTHER WAY, I.E., ANTIBIOTICS HAVE BEEN SHOWN TO MAKE IBS WORSE AS WELL. THE OTHER IDEA IS TO USE PROBIOTICS WHICH CONTAIN "GOOD" BACTERIA (E.G., LACTOBACILLUS OR BIFIDOBACTERIA) WHICH REPLACE THE BAD BACTERIA, POSSIBLY REDUCE THE INFLAMMATION AND IMPROVE SYMPTOMS. SO THE ISSUE OF BACTERIA IN THE BOWEL IS MUCH MORE COMPLICATED THAN SIMPLE SIBO, BUT SIBO CAN BE A PART OF THE WHOLE PICTURE (THOUGH NOT THE WHOLE PICTURE FOR IBS).Dr DrossmanI highly recommend spending four bucks for this article on the whole subject, it is really really worth it."Fact Sheet: Gut Bacteria and Irritable Bowel Syndrome *209* By: Eamonn M. M. Quigley, MDDoes bacteria play a role in IBS? If so, is it helpful or harmful? Bacteria 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 gut bacteria and its host â€" 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 looks at recent findings about possible influences of bacteria in IBS, which may be either negative or positive, and at various treatment approaches."http://www.aboutibs.org/library?page=5&adu...y=id&perPage=10Its about bacteria in general in IBS and SIBO and IBS and the current state of the art on it all. Highly highly worth reading


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## eric (Jul 8, 1999)

PS If you don't fix the motility problem leading to sibo, just killing the bacteria might still leave a person with a problem and they might have to take antibiotics forever, which really isn't a good idea.Sibo and IBS are also seperate conditions. That is an important point here.


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## 20665 (Jan 30, 2007)

I also went through two rounds of Xifaxin, the second being 1200 mg. Following that treatment, I have taken a daily probiotic (Flora Q) recommended by my GI specialist. Three months later, I am symptom-free, but still carefully watching what I eat and slowly adding back foods to my basic diet. The Flora Q is expensive. The best deal I've found is through drugstore.com and costs about $1 per tablet.


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## cynthia (May 9, 2006)

Hi npearce,Sorry to hear that your symptoms came back. But of course the good news is that xifamin works so well for you. - Just wondering about a few things.First - Has anyone heard about doing the xifaxin at the higher dose of 2400 mg/day? I haven't been on this forum for a number of months so maybe there have been discussions about this that I've missed.Also, what is the erythromycin suppose to do?Lastly, I find it incredibly frustrating to read articles and studies that use the word "eradicate" when describing people's improvement while on a specific protocol. It seems like "improve" is what is typically described. Is SIBO ever truly eradicated?


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## 13777 (Sep 5, 2006)

cynthia said:


> Hi npearce,First - Has anyone heard about doing the xifaxin at the higher dose of 2400 mg/day? I haven't been on this forum for a number of months so maybe there have been discussions about this that I've missed.Also, what is the erythromycin suppose to do?Lastly, I find it incredibly frustrating to read articles and studies that use the word "eradicate" when describing people's improvement while on a specific protocol. It seems like "improve" is what is typically described. Is SIBO ever truly eradicated?


These are my opinions:I don't think bacteria is supposed to be eradicated from your your whole gut, just from the small instestines which are, relative to the colon, pretty sterile. Highest Xifaxan dose I have heard of is 1,600 mg. BTW - my GI also put me on erythromycin. It is an antiboitic for acne. But it is also used in very low dosages for motility (it is supposed to improve the "cleansing wave" activity so the bacteria does not mirgate back to the small intestines from the colon, which is considered one major cause of SIBO). I am currently on 800 mg of xifaxan on my third day. First day was great! but then symptoms gradually got worse and now they are worse than before I started. I have heard some people say the symptoms may get worse at first, so I hope that is the case. I just hope I don't get too sick that I wont be able to stick w/ it. Has anyone experienced this before? Please let me know, I could use some positive feedback right now. If this doesn't work, I will try Vivonex (the elemantal diet).be wellkc


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## 17908 (Oct 18, 2006)

cynthia said:


> Hi npearce,Sorry to hear that your symptoms came back. But of course the good news is that xifamin works so well for you. - Just wondering about a few things.First - Has anyone heard about doing the xifaxin at the higher dose of 2400 mg/day? I haven't been on this forum for a number of months so maybe there have been discussions about this that I've missed.Also, what is the erythromycin suppose to do?Lastly, I find it incredibly frustrating to read articles and studies that use the word "eradicate" when describing people's improvement while on a specific protocol. It seems like "improve" is what is typically described. Is SIBO ever truly eradicated?


Erythromycin is technically just an antibiotic; however, it is also used, at times, as a motility agent. Now that Zelnorm is gone, I've been trying erythromycin. It doesn't work nearly as well as Zelnorm, but it seems to work a little bit better than nothing. I'm doing well enough that I'm not sure if I need it, but I'll continue for at least the full 3 months.So far I don't think anything can eradicate SIBO completely. I'm feeling like Xifaxin (the 2nd time around) has helped immensely, but I still have minor symptoms.


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## 17908 (Oct 18, 2006)

KC-in-L.A said:


> These are my opinions:I don't think bacteria is supposed to be eradicated from your your whole gut, just from the small instestines which are, relative to the colon, pretty sterile. Highest Xifaxan dose I have heard of is 1,600 mg. BTW - my GI also put me on erythromycin. It is an antiboitic for acne. But it is also used in very low dosages for motility (it is supposed to improve the "cleansing wave" activity so the bacteria does not mirgate back to the small intestines from the colon, which is considered one major cause of SIBO). I am currently on 800 mg of xifaxan on my third day. First day was great! but then symptoms gradually got worse and now they are worse than before I started. I have heard some people say the symptoms may get worse at first, so I hope that is the case. I just hope I don't get too sick that I wont be able to stick w/ it. Has anyone experienced this before? Please let me know, I could use some positive feedback right now. If this doesn't work, I will try Vivonex (the elemantal diet).be wellkc


Definitely stay on Xifaxin for at least 10 days. You should eventually feel improvement. The first week or more was pretty rough for me, but it was well worth it. I remember on about the 2nd or 3rd day I had a terrible poop attack, and I ran to the bathroom and took a dump so big I thought I was going to have to either flush or stand up to make room for the rest that was still coming. I think my motility was so slow before Xifaxin and Zelnorm/erythromycin that things took a while to make their way through.I'm doing MUCH better now. I poop once to thrice a day, and I have a little gas from time to time. I'm eating a lot of stuff I haven't eaten for a long time.


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