How to determine if an antibiotic is a good candidate?

A reader asked me about the antibiotic Rifaximin. Rifaximin is a sweet antibiotic because it does not enter the blood system much. Lubiprostone, linaclotide and rifaximin with low systemic bioavailability and has been used for irritable bowel syndrome [2014] with some 90 articles on PubMed. On the downside, it is not officially approved and runs $600-$800 /month (likely not covered by US insurance).

So how do you determine if it is a good candidate? I did a brief example in an earlier post.

Criteria 1: Has it shown to be effective for IBS? Ideal is X% remissions, acceptable is improvement. Antibiotics for IBS have been far better studied than CFS, and with 90% of CFS having IBS, it’s a good proxy.

Small intestinal bacterial overgrowth produces symptoms in irritable bowel syndrome which are improved by rifaximin. A pilot study. 2013
Rifaximin treatment for small intestinal bacterial overgrowth in children with irritable bowel syndrome.[2013] ” IBS symptoms improvement in childhood”

Criteria 2: Reduces known overgrowth and does not impact undergrowth.

From an early post, we know what to look for. So take the antibiotic name and each of the items below and see what is known on PubMed.

Klebsiella/Enterobacter HIGH	lesser activity against species of Enterobacteriaceae [1995]
Enterococcus HIGH	good activity against [1995]
Streptococcus HIGH	good activity against [1995]
E.Coli LOW	inhibited in vitro 85.4% of Escherichia coli, [2014]
Bifidobacterium LOW	an increase in concentration of Bifidobacterium [2010]
Lactobacillus LOW	increase in members of the genus Lactobacillus [2012]

And from the gut analysis posts earlier we add:

Rhodospirillales LOW	Nothing
Actinomycetales LOW	Nothing clear
Fusobacteriales LOW	Nothing
Flavobacteriales LOW	Nothing

Criteria 3: Does it release histamines (part of the Herx Reaction)? Because this does not enter the system, it is semi-moot.

Nothing found on PubMed

Criteria 4: Does it promote coagulation or does it thin the blood? In general, you want thinners or should have heparin available if it thickens.

Nothing found on PubMed

Bottom Line: If you are going to supplement with Mutaflor(E.Coli Nissle 1917) and d-ribose immediately after using this antibiotic, then it is a reasonable choice. If you do not have Mutaflor , it is likely a poor choice because of it’s impact on E.Coli. This may be why it only improved IBS and does not result in remission.

Espen Samuelsen 11:10 pm on May 8, 2014

When you say “If you are going to supplement with Mutaflor(E.Coli Nissle 1917) and d-ribose immediately after using this antibiotic, then it is a reasonable choice. “, do you mean IMMEDIATELY as in the same day?

Or as in “do a round of this and then do a round of Mutaflor and D-Ribose”?

And how long would be good? Cycle it for a week at a time? Or do a full month?
- lassesen 3:48 am on May 13, 2014
  
  Yes… d-ribose is one of the sugars that feed e.coli. So think of planting seeds and d-ribose is fertilizer for the seed to help it grown. d-ribose can be taken continuously — d-ribose alone reduced CFS-symptoms according to some studies.
  - Espen Samuelsen 8:31 pm on May 13, 2014
    
    My doctor has allowed me to try it, so it will be exciting.
    
    However, I now have capsules for 28 days (2 x 550mg per day), do you recommend I pulse or do the full 28 days?
    
    And should I do any probiotics (Mutaflor) while taking the antibiotics, or wait until finishing the cycle of antibiotics?
    
    I was thinking perhaps 10 days on Rifaximin, then 10 days Mutaflor, then either back on the Rifaximin again and more Mutaflor, or perhaps some breaks in-between with other probiotics. What do you think?
    
    Also, would it be good to take D-Ribose while taking Rifaximin, or would it also feed the “bad” E.Coli bacteria?
    
    Thanks! 🙂
    - lassesen 11:26 pm on May 19, 2014
      
      Sorry, I thought that I had answered this. nagMail is welcome.
      
      1) Prescript Assist is always a good probiotic to do when taking any antibiotics. It was originally designed to repair antibiotic damage.
      2) There is no literature on (Rifaximin mutaflor)
      3) ” Rifaximin-resistant isolates were also found, particularly in bacteria belonging to Bifidobacterium genus,” http://www.ncbi.nlm.nih.gov/pubmed/12120885 [2002], so take Bifidobacterium with it.
      4) “Rifaximin did not affect the overall composition of the gut microbiota, whereas it caused an increase in concentration of Bifidobacterium, Atopobium and Faecalibacterium prausnitzii. ” http://www.ncbi.nlm.nih.gov/pubmed/20852272 [2010] — all good stuff
      
      Since the goal is to eliminate bad E.Coli, I would suggest 2 weeks on, then 2 weeks of haritaki, then EDTA + Rifaximin for another 2 weeks, then haritaki + EDTA.
      
      You may also care to read my post on herbs for Crohns (which are anti-E.Coli herbs)
      - Charlie 9:24 am on July 5, 2016
        
        Hi, what are your thoughts on the following:
        
        “Rifaximin is a safe, nearly non-absorbable (<0.4%) antibiotic with action directed at the gut bacterial flora. Two properties of rifaximin provide excellent safety profile. The first property is that rifaximin requires bile salts for solubility. As bile salts are removed from the lumen in the terminal ileum, rifaximin becomes insoluble going across the ileocecal valve as it loses bile salts. The consequence of this site specific effect is that rifaximin spares the colonic flora and is therefore an antibiotic that exclusively targets the small intestine. ”
        
        http://www.google.com/patents/US20080161337
        
        Does this mean whilst effrective if your dysbiosis is in the small intestine its unlikely to have much of an impact on large intestine dysbiosis?
        
        lassesen 11:44 am on July 5, 2016
        
        See https://cfsremission.wordpress.com/2015/12/27/rifaximin-and-cfs/

CFS Remission

Striving for true remission of CFS, chronic Lyme, FM, IBS etc

How to determine if an antibiotic is a good candidate?

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