Expert: Dr Alan Galbraith - 4/26/2009

Question
QUESTION: Dear Dr. Galbraith:

My question is regarding irritable bow syndrome caused by intestinal bacterial overgrowth.  When i was in America a few years ago, my doctor prescribed me rifaximin (Xifaxan) for 7 days to treat small intestinal bacterial overgrowth (SIBO). I am currently in a country that doesn't have rifaximin.  Can you please help me with some alternatives that work as well as rifaximin.  I am currently in the country of Israel which has most drugs but for some reason doesn't have rifaximin.  

Thank you in advance for you help.  


ANSWER: Dear Tim

There are many antibiotics useful here and some should be available in Israel. I would recommend in the first instance, doxycycline and if this does not help themn try ciprofloxacin or a related fluoroquinolone.

Regards

Alan Galbraith

---------- FOLLOW-UP ----------

QUESTION: Dear Dr. Galbraith:

Thank you for you last response.  Can you please give your opinion on the drug rifampicin as a substitue for rifaximin for the treatment of small intestinal bacterial overgrowth (SIBO).  As i stated previously rifaximin isn't available in the country i am in but rifampicin is available.  Do you think rifampicin is a better choice/substitute than doxycycline or a ciprofloxacin or a related fluoroquinolone.

Thanks,


Answer
Dear Tim

Rifampicin is related to rifamixin but should be reserved for very serious infections such as TB, leprosy etc and to my knowledge is never used for GI infections because of this and its unpleasant adverse effect profile. I would stick to recognised treatments as I suggested in my previous communication as this is one of their main uses and are much safer.

Regards

Alan Galbraith