# Rifaximin and neomycin together?



## SteveInAustin

Hi. I'm new to the forum.I see in Dr. Mark Pimentel's book, he says that for those that have already gone on one course of rifaximin yet didn't clear things up, they should go on a second course of antibiotics, but this time it should be a combination of rifaximin and neomycin together. I understand that the rifaximin dosage studied by itself was 1200mg per day (400mg @ 3x/day). But what would the dosages of rifaximin and neomycin be when combined?By the way, my doctor put me on rifaximin for IBS at a dosage of 800mg/day (400mg @ 2x/day). That resulted in an almost 100% cure of all my symptoms within 3 days after the initial dosage. I started feeling it working after just one day. It was like night and day. I felt completely normal. But after the 10 day course was done, it took about 5 days for it to return. It returned, but it wasn't as severe. I have diarrhea type IBS also, which is more respondent to rifaximin?If I don't do neomycin in this next course, I'll try to ask for a higher dosage of rifaximin for a longer period of time. I'm thinking 1200mg/day (400mg @ 3x/day) for 14 days. And if that doesn't work, I'll go on either a 3rd course or I'll try the Vivonex diet.Also, I'll ask for erythromycin at 50mg once daily at night for me to take following the last dose of rifaximin I take. My doctor didn't do this for me the first time. I understand Zelnorm has been pulled off the market, also. Is erythromycin sufficient?Oh, I also went a little overboard with probiotics. Bought a ton of pills, tons of yogurt, etc. It seems to get a response from me, but it's unsustainable. After fasting on just yogurt and probiotic pills for one whole day, the next 2-3 days are very good for me. During the yogurt fast, my IBS is the worst ever. Also, I used to take pills and yogurt in between meals, but now I'm off of them for the most part and things have gotten better since I've been off of them. So something is going on there. But after reading Dr. Pimentel's book, I'm thinking that probiotics may be setting my progress back. I think I'll only take a small amount of yogurt and no probiotic pills after my second course of antibiotics completes. What do you all think?Thanks,Steve


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## SpAsMaN*

If Rifaximin appears to improve something,it is most likely to be IBS-D because it is FDA approove for travellers-diarrhea.It makes my IBS-C worst BTW.I'm glad it help your IBS-D tho.PS: i disagree that a constipated should use Rifaximin just like i disagree that a constipated take Immodium...


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## SteveInAustin

My doctor put me on a second course of rifaximin at 800mg/day (400mg x 2). This time instead of 10 days, he's having me do it for 30 days. I asked for 1200mg/day but he said that since it worked last time at 800mg/day, he saw no need to up it. He added that it's been tested at 800mg, but not 1200mg (I believe he's incorrect).I also asked for erythromycin at 50mg at night like the book says, and my doc shot that down saying that e-mycin causes people discomfort, even in that low dosage. He said that my problem isn't that my small intestine isn't making cleansing waves, it's that the antibiotics didn't get all the bacteria. He figures this 30 day course should do the trick. Who knows, he may be right. I really wanted the e-mycin at night, though.He also shot down the idea of doing neomycin in addition to rifaximin, because he said neomycin has bad side-effects, and besides rifaximin works.I can think of several reasons why he's perhaps wrong on all those points, but for now I'm fine with the 30 day course of rifaximin. If it doesn't work out after this, I'll consider other options. I wonder if Dr. Pimentel can prescribe by phone interview and mailed medical records.Oh, as for my new course, I'm already feeling almost normal again after being back on rifaximin for 4 days. My intestines are still spasming every now and then. Like a little buzzer going off for a few seconds and then stopping. But no bloating. No noises, usually. Still a bit of gas, but probably about normal or maybe even a little less than normal for the average non-IBS person. The spasms are weird, though. I never used to have that, not until I got IBS about 9 months ago. That seems to have a neuromuscular cause, I would imagine. Perhaps the result of toxins given off by bacteria? Or maybe a genetic cause? Or viral? Wish I knew. Bacteria are definitely part of the equation, but maybe not the whole equation.Steve


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## 19698

Hi There,I actually have just stopped the antibiotic treatement about a week ago. I took the 1200mg/day of rifamixin and it seemed to work when I was on it, but now my system seems very messed up. I am ibs D and have been for as long as I can remember. After taking this medicine, I seem to be C sometimes and then D. It is horrible for me as I never have know n what C felt like







I see my doctor on Tuesday and I will ask him about combining the two antibiotics, although i think the other one n..... is for ibs C. Like you i have tried probiotics and had great success with the activia yogurt, but the benefits lasted exactly 1 month and then I was right back to the way I always have been. Let me know if you find anything else out and I will let you know what the doc says on tuesday.


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## JeffnSD

Hey Steve,Just wondering how you are doing with the rifaximin?I have IBS-D and have just been introduced to this Dr. Pimentel book. I read the whole book and it makes such sense for me. I'm going to my doctor this week to start this train of thought. I figured it out when I took CIPRO 2 weeks ago and my symptoms disappeared. But when I stopped it...they all came right back. So now I want to try this rifaximin. I'm hoping its my cure!!! Have you had any side effects? Did you ever combine both rifaximin and neomycin? If so..what was your dosage?I read all about the cleansing wave thing and wonder if thats really more for IBS-C folks. I have no problem going and would love to be constipated!! haha. Maybe our gut motility is overactive so we dont need that assistance. Just wondering about your update.Also..I noticed when I took probiotics my D got worse! I couldn't figure it out. Probiotics are supposed to help. But if you recall in the book...bacteria is neither good or bad. Its just where its located. So to me..to add more bacteria, even if its good...could set us back a few steps if our systems are already prone to overgrowth.Jeff


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## starwoman

I have read the book too, and would be most interested to hear how you get on taking the anibiotics, I have tried everything else with no sauccess.Cheers,Carmen [email protected]


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## eric

Jeff, did they actually test you for sibo? What kind of test was it?you do know the role of sibo in ibs is a highly controversial issue, based on speculation. There is a real condition of sibo and there is a real condition of IBS, but they are not the same conditions.also some people may have both conditions.A lot of doctors seem to be giving out antibiotics without testing for sibo. Also one of the tests for sibo is not very accurate.Have you all seen this newer study?Bacterial Overgrowth Apparently Not Important in IBSBy David DouglasNEW YORK (Reuters Health) Jun 04 - An abnormally high number of bacteria in the small intestine does not appear to be a major factor underlying symptoms of irritable bowel syndrome (IBS), Swedish researchers report in the June issue of Gut."The data," senior investigator Dr. Magnus Simren told Reuters Health, "do not support an important role for small intestinal bacterial overgrowth, according to commonly used clinical definitions, in IBS."Dr. Simren and colleagues at Sahlgrenska University Hospital, Gothenburg note that a high prevalence of small intestinal bacterial overgrowth has been reported in patients with IBS, but those results were based on indirect determination using hydrogen breath tests.They therefore assessed small intestinal bacterial overgrowth by a direct test -- bacterial culture of small-bowel aspirates -- among 162 patients with IBS and 26 healthy controls. Cultures revealed small intestinal bacterial overgrowth in 4% of patients and 4% of controls.Signs of enteric dysmotility were seen in 86% of patients with overgrowth and in 39% of patients without. Nevertheless, say the investigators, motility alterations could not reliably predict altered small-bowel bacterial flora."However," said Dr. Simren, "mildly increased counts of small-bowel bacteria seem to be more common in IBS," but "its clinical relevance remains unclear."Gut 2007;56:802-808.also this is worth readingTreatment for Bacterial Overgrowth in the Irritable Bowel Syndromehttp://216.109.125.130/search/cache?ei=UTF...=1&.intl=us


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## karoe

If I have SIBO alongside my "IBS" I'd like to treat it, thank you. Nothing like having something ELSE wrong with you, besides the IBS!!! So, give me the test and we'll see....how about that, a gastro test that finally finds something wrong with me! I go Nov 12 to the gastro at Kaiser and I am preparing to be dissapointed --- I don't see these docs in the HMO bending over backward to help me. But if I have the symptoms of SIBO, and a history of being symptom free on antibiotics, why shouldn't he want to test me?


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## starwoman

Hi Eric,I too have tried Rifamaxim, however I am starting to think IBD coule be a vasculitus illness, of bad circulation etc.Cheers,Carmen


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