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.

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.