It is important to reduce carbohydrates (bread, pasta, rice, cereal, dairy with lactose and fruit) during this time and continue to take the medication. If there is a relapse of the infection with return of the original symptoms, then Xifaxan or other antibiotics will need to be prescribed again.ĭuring the first few days of Xifaxan treatment it is not unusual to have more gas, discomfort and diarrhea. In individuals where we suspect that there has been damage to the lining of the small intestine by SIBO, we will try to help repair this intestinal permeability (also known as “leaky gut”) with 1 month of Zinc 200 milligrams daily and a probiotic capsule (healthy bacteria – examples include Align and Flora-Q). Some individuals may benefit from other medications. In cases where erythromycin, naltrexone, or Align are not effective, then periodic or maintenance doses of Xifaxan may be prescribed. Naltrexone is an anti-opioid medication that can stimulate small intestinal activity. For those who are allergic to erythromycin, Align probiotic can be taken once nightly to try to help prevent SIBO. Medication is often needed as a long term treatment to prevent relapse of SIBO. Erythromycin is a common antibiotic has properties of a hormone that stimulates small intestinal muscular activity. Neomycin is often prescribed with Xifaxan where there are excess methane-producing bacteria.Īfter antibiotic treatment is finished and the symptoms improve, then we treat the underlying muscular disturbance with either low dose erythromycin or naltrexone each night at bedtime. Neomycin can rarely cause hearing loss or kidney problems when there are pre-existing problems. Flagyl (metronidazole) can cause a temporary metallic taste and nausea rarely with short term treatment, there can be numbness or tingling in the arms or legs. Cipro and Augmentin can cause rash and antibiotic associated diarrhea. These antibiotics (Cipro, Augmentin, Flagyl, and Neomycin) each have their own risks and side effects. When the insurance company refuses to pay for Xifaxan and the program to help get certification, other antibiotics can be used. A program to help with reimbursement by your insurance is available through Salix Pharmaceuticals (1-86). This non-absorbable, small intestinal targeting antibiotic is taken as follows: six pills a day for ten to twenty days depending on the severity of the breath test abnormality. To treat SIBO we like to start with an antibiotic called Xifaxan. The effect can last for many years and as a result the normally small population of small intestinal bacteria will grow. This disorder can result from an insult caused by infection in the past (including traveler’s diarrhea, gastroenteritis, and food poisoning). It is during these muscular contractions that the small intestine is stripped clean and by doing so keeping the bacterial population low.
The most common cause of SIBO is the reduction of the normal cycle of muscular activity of the small intestine at night.
The effects of SIBO in people include a variety of symptoms including bloating, gas, pain, diarrhea, constipation, irritable bowel syndrome, muscle pain (fibromyalgia), interstitial cystitis, restless leg syndrome, rosacea, and bad breath.
The majority of the gas that is produced by bacteria in the small intestine and then most of it is eventually absorbed by the lining and then taken up in the blood stream and then is expelled through the lungs. If the gas levels rise quickly and to an abnormal level a diagnosis of small intestinal bacterial overgrowth can be made and treated. Gas levels rise as the sugar solution passes through the intestine resulting from fermentation of the sugar by bacteria. In this test, a non-absorbable sugar solution is swallowed and hydrogen and methane gases are measured in the breath. It can be diagnosed by the lactulose breath test. SIBO can be caused by many gastrointestinal conditions. Small Intestinal Bacterial Overgrowth (SIBO) is a condition where the small intestine is populated by an abnormal amount and/or types of bacteria.