Guidelines for Treating SIBO with Xifaxan - Dominick Hussey

Guidelines for Treating SIBO with Xifaxan

When considering using antibiotic treatment of SIBO, Xifaxan is the most well known and researched. Xifaxan is the treatment of choice for the majority of medical doctors for SIBO. As a non-prescribing health practitioner, I predominantly recommend botanicals, but I do see a place for using Xifaxan in the treatment of SIBO.

In this article, I outline the benefits and disadvantages of Xfaxan, Xifaxan versus Refaximin, Xifaxan versus a herbal protocol and common Xifaxan treatment protocols.

Advantages of Xifaxan over other antibiotics

Xifaxan is a unique drug with some unusual properties that mean it has some benefits over other antibiotics.

  1. 99.6 percent of Xifaxan remains in the gut. Because of this localised activity, it has risks compared to other antibiotics.
  2. Xifaxan has very low potential for drug interaction
  3. Xifaxan does not have a significant impact on the colon and the microbiota. On the contrary, some studies have shown that Xifaxan increases numbers of beneficial species including Bifidobacterium and F. prausnitzii.
  4. Rxifaxan is remarkably safe for an antibiotic. In a study published in 2014, Researchers found that when subjects took Xifaxan for up to two years at a dose of 1,100 milligrams per day, there was no increase in the rate of infections, including with Clostridium difficile, or development of bacterial antibiotic resistance.

Disadvantages of Xifaxan

There are two main disadvantages of Xifaxan

  1. Xifaxan is very expensive. Xifaxan cots between USD 1,000 and 2,000 for a month-long course.
  2. There is no approval of Xifaxan for the treatment of SIBO in the United States. I am not sure about in Canada.

Xifaxan versus Refaximin

It is important to realise that Xifaxan and Refaximin are technically not the same drugs. Xifaxan is the brand name while Refaximin is the generic name of the drug. Because Refaxamin is generic by definition, it is much cheaper to buy. However, regarding research, the majority of the studies that have been looking at the efficacy and safety of the medication were using Xifaxan.

Xifaxan versus a Herbal protocol

In my practice, two situations lead me to consider recommending Xifaxan.

  1. If a patient has tried a botanical protocol and failed
  2. If the patient is hypersensitive to the herbs or suspects that they won’t tolerate a botanical protocol

Common Xifaxan Treatment Protocols

From research, there are two chief Xifaxan dose regimens commonly in use for adults. Rifaximin comes in 200 milligrams and 550-milligram quantities.

  1. 400 milligrams three times a day, which is a total of 1,200 milligrams a day for 10 to 14 days
  2. 550 milligrams three times a day, which is 1,650 milligrams a day for 10 to 14 days

Th second dose is what’s more commonly used by specialists who treat SIBO at this point.

For children, studies have used different protocols including:

  1. 600 milligrams per day for seven days that led to a 64 percent normalisation of lactulose breath test in kids ranging from three to 15 years of age that are an average of 10 years old.
  2. Other studies in kids with IBD who were treated with rifaximin. They used dosages ranging from 10 to 30 milligrams per kilogram of body weight and achieved a 61 percent symptom relief.



This article is not intended to provide medical advice, diagnosis or treatment.

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