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Thread: what is proper dosing for flagyl to treat SIBO?

  1. #1

    what is proper dosing for flagyl to treat SIBO?

    i just need to know from Wise Young or an SCI nurse what the proper dosing schedule is for flagyl when treating Small Intestine Bacterial Overgrowth.

    i was treated w/ 2 weeks of cipro last month, and it helped my abd pain A LOT! but it didn't fully eradicate my symptoms. now the doc wants to wait a couple months to do the hydrogen breath test [which isn't even a good test for SIBO, but there's nothing else]. i'm not willing to do this wait & see approach. April 6th will be 6 years of horrible abd pain, w/ doctors always taking a wait & see approach. this is the FIRST treatment that has helped. according to this website, provided by an SCI Nurse here at CC http://www.medicinenet.com/small_int...owth/page6.htm both flagyl and rifaximin are also treatments. i am going to use them.

    i need to know the mg/dosages/times per day for these meds. after 6 years, and finding something that's working, i am going to self medicate. please help me w/ the proper dosing info.

  2. #2
    Excerpt from:
    http://www.medicinenet.com/small_int...owth/page7.htm

    How is small intestinal bacterial overgrowth treated?

    "Classic" SIBO
    SIBO has been recognized for many years as a problem with severe disorders of intestinal muscles and intestinal obstruction. The treatment has been antibiotics, and they are very effective. The difficulty is that the disease causing the SIBO often cannot be corrected. As a result, symptoms frequently return when antibiotics are stopped, and it may be necessary to treat the patient with antibiotics repeatedly or even continuously.

    SIBO associated with IBS
    There are very few rigorous, scientific studies on the treatment of irritable bowel syndrome with therapies that are directed specifically to the possibility of underlying SIBO. That has not stopped physicians from trying unproven treatments. The discussion of treatment that follows is based on the minimal scientific evidence that is available as well as the anecdotal (observed but not scientifically demonstrated) experience of physicians who see patients with irritable bowel syndrome.

    The two most common treatments for SIBO among patients with irritable bowel syndrome are oral antibiotics and probiotics. Probiotics are live bacteria that, when ingested by an individual, result in a health benefit. The most common probiotic bacteria are lactobacilli (also used in the production of yogurt) and bifidobacteria. Both of these bacteria are found in the intestine of normal individuals. There are numerous explanations for how probiotic bacteria might benefit individuals. However, the beneficial action has not been identified clearly. It may be that the probiotic bacteria inhibit other bacteria in the intestine that may be causing symptoms, or it may be that the probiotic bacteria act on the host's intestinal immune system to suppress inflammation.

    Several antibiotics either alone or in combination have been reported to be successful. Treatment success, when measured by either symptom improvements or by normalization of the hydrogen breath test, ranges from 40-70%. When one antibiotic fails, the doctor may add another antibiotic or change to a different antibiotic. However, the doses of antibiotics, the duration of treatment, and the need for maintenance therapy to prevent recurrence of SIBO have not been adequately studied. Most physicians use standard doses of antibiotics for one to two weeks. Probiotics may be used alone, in combination with antibiotics, or for prolonged maintenance. When probiotics are used, it probably is best to use one of the several probiotics that have been studied in medical trials and shown to have effects on the small intestine, though not necessarily in SIBO. The commonly sold probiotics in health-food stores may not be effective. Moreover, they often do not contain the bacteria stated on the label or the bacteria are dead. The following are some treatment options:

    * Neomycin orally for 10 days. One observation that has been made is that neomycin eradicates methane-producing bacteria and alleviates constipation.

    * Levofloxacin (Levaquin) or ciprofloxacin (Cipro) for 7 days.

    * Metronidazole (Flagyl) for 7 days.

    * Levofloxacin (Levaquin) combined with metronidazole (Flagyl) for 7 days.

    * Rifaximin (Xifaxan) for 7 days. Rifaximin is a unique antibiotic that is not absorbed from the intestine, and, therefore, acts only within the intestine. Because very little rifaximin is absorbed into the body, it has few important side effects. Higher than normal doses of rifaximin (1200 mg/day for 7 days) were superior to standard lower doses (800 or 400 mg/day) in normalizing the hydrogen breath test in patients with SIBO and IBS. However, it is not yet known whether the larger dose is any better at suppressing symptoms.

    * Commercially available probiotics such as VSL#3 or Flora-Q, which are mixtures of several different bacterial species, have been used for treating SIBO and IBS, but their effectiveness is not known. Bifidobacterium infantis 35624 is the only probiotic that has been demonstrated to be effective for treating patients with IBS.

    Treatment with antibiotics versus probiotics

    It is the author's personal belief that for short-term (1-2 weeks) treatment, antibiotics are more effective than probiotics. However, antibiotics do have certain disadvantages. Specifically, symptoms tend to recur after treatment is discontinued, and prolonged or repeated courses of treatment may be necessary in some patients. Physicians are reluctant to prescribe prolonged or repeated courses of antibiotics because of concern over long-term side effects of the antibiotics and the emergence of bacteria that are resistant to the antibiotics. Physicians have less concern over long-term side effects or the emergence of resistant bacteria with probiotics and, therefore, are more willing to prescribe probiotics repeatedly and for prolonged periods. One option is to initially treat the patient with a short course of antibiotics and then long-term with probiotics. Long-term studies comparing antibiotics, probiotics, and combinations of antibiotics and probiotics are badly needed.


    All the best,
    GJ

  3. #3
    yes i saw that.

    it doesn't state mgs/frequency, it only says how many days.

    i need to know how many mgs & how many times per day.

  4. #4
    HI,

    Unfortunately, I do not recommend self-medicating especially because there are side effects as well as varying doses ( for flagyl 250mg and 500mg) and dosage is depending on one's medical history, such as kidney function.
    Why not call your doctor and provide them with this literature and discuss your issues? If you have had this for 6 years and the usual treatments have not worked, they should be open to this. If not, consider another doctor's opinion.

    AAD

  5. #5
    i've done that. i understand what ur saying, but over these years i get the same "wait & see" approach.

    i've made up my mind only after hitting dead ends repeatedly. if u won't inform me of proper dosing, i'll have to guess.

  6. #6
    Quote Originally Posted by sittinsux View Post
    i've done that. i understand what ur saying, but over these years i get the same "wait & see" approach.

    i've made up my mind only after hitting dead ends repeatedly. if u won't inform me of proper dosing, i'll have to guess.
    This may be an naive question....but where do you get Flagyl without benefit of a script from a licensed doctor? Besides...how do you know that Flagyl is what you need for your particular situation? Take this into consideration:
    Excerpt from: http://www.oley.org/lifeline/bacter.html
    Antibiotics
    If the dietary therapy is insufficient to control symptoms, it should be continued with the addition of antibiotics. Broad spectrum antibiotics, such as Bactrim and Flagyl, used continuously, at half the usual antibiotic dose, are often very effective. Trials of different antibiotics may be needed to find the right combination. In addition to Bactrim and Flagyl, we have found Augmentum and Keflex to be beneficial. Our most severe case of small bowel bacterial overgrowth was a child with short bowel syndrome who suffered severe d-lactic acidosis with seizures. He went through several treatment regimes before we identified oral Vancomycin, a potent antibiotic, as an effective measure to control his overgrowth. After the acute overgrowth has been controlled, antibiotic therapy may be required only for a few days out of every month or may be so severe as to require prolonged continuous therapy. If symptoms reappear after a few months, switching antibiotics is often necessary. We have seen no development of antibiotic resistant complications utilizing this therapy over prolonged periods of time, probably because of the lower doses utilized.


    Maybe your case would respond better to Augmentum, Keflex, Bactrim, Vancomycin, Xifaxan (rifaximin) Levofloxacin (Levaquin) or some combination therapy. If you have tried Flagyl in the past and are still suffering with this, then you need to try some other drug therapies under the guidance of a physician. I did find several references citing Flagyl dosing (xxx mg/x times per day) by doing an internet search, three in fact....and they were all different mg and times per day. I also read a lot about people taking Flagyl and it worked for some short time. Then their physician switched them to Keflex and that worked for some short time. Obviously, for this disease there is no one size fits all fix.

    I would urge you to keep trying until you find a doctor who will work with you on this. Have you seen an infectious disease physician? When I was going through a marathon bout of urinary tract infections, I worked with my infectious disease doctor for about 8 months to beat them.

    All the best,
    GJ

  7. #7
    I was going to edit my last post to your thread, but since an edit doesn't kick the thread back up to the top and you may have already read my last post, I just want to throw this out to you. If you are messing around with antibiotics on your own you could end up with a case of Clostridium difficile, also known as C. dif. You really don't want to go there (or maybe that is where you are now).
    http://www.mayoclinic.com/health/c-difficile/DS00736

    Take care and get some professional help, no matter how many doctors you need to go through before you find the right match.

    All the best,
    GJ

  8. #8
    Quote Originally Posted by sittinsux View Post
    i just need to know from Wise Young or an SCI nurse what the proper dosing schedule is for flagyl when treating Small Intestine Bacterial Overgrowth.

    i was treated w/ 2 weeks of cipro last month, and it helped my abd pain A LOT! but it didn't fully eradicate my symptoms. now the doc wants to wait a couple months to do the hydrogen breath test [which isn't even a good test for SIBO, but there's nothing else]. i'm not willing to do this wait & see approach. April 6th will be 6 years of horrible abd pain, w/ doctors always taking a wait & see approach. this is the FIRST treatment that has helped. according to this website, provided by an SCI Nurse here at CC http://www.medicinenet.com/small_int...owth/page6.htm both flagyl and rifaximin are also treatments. i am going to use them.

    i need to know the mg/dosages/times per day for these meds. after 6 years, and finding something that's working, i am going to self medicate. please help me w/ the proper dosing info.

    i appreciate u trying to help, but ur stating all the things i already know. what i'm trying to find out is proper dosing schedule for flagyl to treat Small Intestine Bacterial Overgrowth Syndrome. that's it. as i stated in my first post.

  9. #9
    Quote Originally Posted by sittinsux View Post
    i appreciate u trying to help, but ur stating all the things i already know. what i'm trying to find out is proper dosing schedule for flagyl to treat Small Intestine Bacterial Overgrowth Syndrome. that's it. as i stated in my first post.
    I think those of us who have replied understand exactly what you are asking. You don't seem to understand that we think you should get this information from a prescribing physician, and we are trying to point out to you the risks of self medicating.

    All the best,
    GJ

  10. #10
    wow? really? never thought of that. geez...

    i'm not going to write the full 6 year history of this which has led to my conclusion. someone w/ the info can either provide it, or not comment. i don't need a 'mom'. every doc just wants to "wait & see". no thanks. i can get the meds, i'm moving fwd.

    i'm asking for info from SCI Nurse or someone w/ specific SIBO info. from everything i've read, i have far better info than u provided. my best friend from college is a doctor, but he's a radiologist who spent some time as a fam practice physician and doesn't have the specific info on this subject. however, he affirmed that flagyl basically has no downside, very little risk of building resistance, just as Rifaximin, which will be my next step.

    SCI Nurse, if u have the proper dosing schedule, i'd appreciate it. please. thanks.

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