How effective is Rifaximin in treatment of post infection IBS?

Posted on Fri, 12 Jun 2015 in General Health
Question: My name is XXXXXXX and i am re-opening my case earlier answered by your few days back.
As advised by you i got my stool culture done. (reports attached, e.coli is isolated).
I visited GI ( before culture report) who repeated endoscopy and found that this time it is absolutely normal ( gastiritis which was detected earlier is also cleared) when i talked about bacteria overgrowth he presribed me metronidozole 400 mg x 3 times in a day . I followed his prescription for five days and i have great improvement especially in bloating. I have also purchased rifraxamin 400 mg and intend to take if needed. But i still have air ( not a gas) movement in my stomach especially when i am empty stomach and feel slight bloated if i eat full meal immidiately after long fasting bloating goes away within 1.5~2 hours.
I have also attached my colonoscopy and ttg-a test (0.6 U/ML) report for your reference which was not attached earlier. My GI says that most likely it is a post infection IBS or any functional disorder and since biopsy report of elium is negative which confirms that you are not suffering from crohn's disease because this is kind of tissue disorder confirmed by biopsy of elium.
Kindly also advise if i try rifraxamin 400 mg x3 times after having metronidozole 400 3 times for 5 days.
Thanks and regards XXXXXXX
Answered by Dr. Grzegorz Stanko 1 hour later
Brief Answer:
Rifaximine treatment should be tried.

Detailed Answer:
Your stool culture test is fine. E.Coli is a bacteria present naturally in large intestine. So no wonder it has been isolated. There is no other, disease causing bacteria present so this is a good result. In some cases there is a need to precise genetic type of E.Coli. It is possible to be infected by E.Coli called O157:H7. But this is possible only if you have had any foreign travel before the symptoms has started. If so, you should ask the lab to identify what kind of E.Coli this is.

Metronidazole is effective against non-aerobic bacteria. But it does not eliminate most of aerobic bacteria. This is why you may still feel the air moving inside your stomach. And this is why Metronodazole may be not enough. So in my opinion you should try Rifaximine treatment. You can try it right away.
Its much better than Metronidazole alone. You should continue probiotic intake during the Metronidazole and Rifaxmine therapy.

If the Rifaximine wont be effective, CT enteroclysis seems to be the next step.

Hope this will help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Grzegorz Stanko 34 hours later
Hi Doctor

I have started taking rifaximin 400 mg, 1/2 hour after meals 3 times a day and reduced my sugar intake and stopped milk.
. I am taking probiotic Bioflor ( gut regulator) generic name ( Lyophilized Saccharmocyes boulardi) purchased OTC from watson store, and 1 chewable tablet 2 times of lactobacillus reuteri ( supplement) after food.
As i am from XXXXXXX origin and pure vegeteranian, so yogurt ( curd) is my routine diet.
Please advise if these medicines should be taken after food or before food ?
or is there any better probiotics which can be more effective than those mentioned above.
Thanks and Regards XXXXXXX

Dear Doctor

I forgot to tell you that I am hypothyroid patient too. Taking thyroxin harmons 75 mg daily in the morning

Thank you for your attention
Answered by Dr. Grzegorz Stanko 7 hours later
Brief Answer:
Rifaximine can be taken at any time.

Detailed Answer:
There is no difference if Rifaximine will be taken before or after meals. As it does not get absorbed from intestines, and stays inside intestine, foods do not worsen or improve its effect.
You probiotic is fine No need to change it. Yogurt is also a very good idea.
Thyroxin does not impact your treatment. So carry on.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Grzegorz Stanko 12 hours later
Hi Doctor !

I am sharing with you discomfort i experienced after taking 4 doses of rifaximin 400 mg.

I feel burning and acidity in the stomach after taking even i woke up in the middle of night 2 times to take antacid.

Too much gas movement inside the stomach and motion with cramping

I passed loose motion
Previously i used to feel fullness which i try to relief by burping but no visible distention or tightness in the stomach after eating but yesterday after 4th dose i felt stomach distended and become tight with gas movment blocked and morning i passed loose motion.

Kindly advise if these are common side effects of antibiotic or I should try with low dose ( 200mg) to see if i tolerate medicine well.
regards XXXXXXX
Answered by Dr. Grzegorz Stanko 12 hours later
Brief Answer:
Try to lower the dosage.

Detailed Answer:
This is not common side effect of Rifaximine. You may try to lower the dosage to 200 mgs. But if this wont help, stop taking it.
Like I have mentioned earlier, CT enteroclysis might be necessary as this does not have to be bacteria related issue. Your current symptoms are more characteristic for some intestine narrowing than bacterial problem or Rifaximine side effect.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Grzegorz Stanko 22 hours later
Hi Doctor !

As you mentioned I have booked appointment with another GI to get referral for CT enteroclysis. In hong kong without doctor referral it is not possible and my current GI thinks i have a functional disorder IBS,.

I would like to share following
I continued rifaximin 400 for next day and after lunch when i went for a short walk i felt dizziness and almost fainting, I stopped taking rifaximin immediately.

But interistingly i noticed that same day after dinner i did not have any discomfort usually i used to have lot of burping and heaviness in upper stomach. My stomach was absolutely soft without having any feeling of fullness. Samething i observed after taking breakfast and lunch on the next day. I did following
> I took antibiotic rifaxamin ( 6 doses)
> stopped acid suppressant for almost a week ( i was taking it for almost last 4 months)
> Stopped milk for almost a week
> I tried lemon honey ginger tea
> Took metronidozole 400 for 5 days last week ( which i could tolerate )
Though i feel slightly acidic after eating but no fullness i am monitoring my symptoms.

Can above information be useful for you to further diagnose my problem.
thank you
regards XXXXXXX

Answered by Dr. Grzegorz Stanko 25 minutes later
Brief Answer:
Rifaximine can not cause dizziness.

Detailed Answer:
I really do not think Rifaximine could cause dizziness. This antibiotic does not get absorbed from intestines. It can appear in the blood in only 1% of whole dosage. This is way too less to cause anything. That is why it very safe medication.
Dizziness is rather an effect of diarrhea and possible slight dehydration and/or ions deficiency. So this should be fixed with increased mineral water intake (or drinks like Gatorade used by sportsman for example). If this is true theory (about dehydration) you should notice darker urine and less amount of it.

The rest is very promising. It seems like Rifaximine along with quitting antiacids could help. If so, the small intestine bacterial overgrowth could be the case. But you need to wait few more days to see if this is just a coincidence or the effect is permanent. During that time try to avoid any fatty foods, spicy foods, coffee, apples, broccoli, cabbage, sweats and soft drinks.

You may wait few more days before you will decide about the enteroclysis.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Grzegorz Stanko

General Surgeon

Practicing since :2008

Answered : 5768 Questions


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