Sibo & Medications

[Loobyloo12]

I have had diffuse systemic scleroderma since 2011, I am 71 years of age. I had my first bout of sibo a year ago, for which I was prescribed metronidazole followed by co-amoxiclav, that worked perfectly. I have recently had another episode of sibo & took the same drugs, but it seems to be coming back again. The problem I am having with all this is having to stop methotrexate & nifedipine while on antibiotics, (I had a bad reaction with antibiotics & amlodipine before - dropped my blood pressure drastically). I was wondering what others do regarding antibiotics for sibo with other meds as I don’t like stopping my drugs all the time.

Many thanks

[Hidden]

Did you do anything else to address the SIBO other than antibiotics?? The antibiotics may help in the short term but long term you need to address diet and lifestyle factors to get on top of the root cause of your SIBO and prevent it reoccurring. The antibiotics will target the problematic bacteria but will also reduce your good bacteria, allowing the problematic ones to grow back again.

[Loobyloo12 in reply to Hidden]

Thankyou for your reply. I am under the care of a dietitian now, but as I am so underweight ( barely 6st), he doesn’t want me to do the fodmap diet at this point, told me to eat normally for now ( although I am careful what I eat). He also has me drinking 2 ensure a day. I also have severe osteoporosis for which my consultant also wants me to try to put on weight. I just get concerned with stopping methotrexate & also nifedipine ( Raynauds), I feel as though it’s a never ending circle.

[MissusTee]

I get SIBO a lot, and got fed up with all of the antibiotics. I now use kefir drinks and they seem to manage my symptoms really well.

[Halfwayuphill]

Hello Loobyloo

I have had to resort to rotating antibiotics for SIBO and have tried all sorts of alternatives (herbal antibiotics, diet etc) and apart from tweaking my diet have given up as like you I’m just over 6 stone. Im 69 so similar age. I don’t have a problem with Amlodipine and the antibiotics though. Has your rheumatologist let you try Rifaximin? It has less side effects and I wondered if you could take it with Amlodipine. It’s now prescribed for Scleroderma SIBO but most gp’s won’t. The Royal Free (where I go) has a leaflet telling you which antibiotics you can rotate. There is a probiotic I take which is tolerated I find with this Saccaromyces Boulardii. I do hope you get some relief from this.

[Loobyloo12 in reply to Halfwayuphill]

Thanks for your reply. Unfortunately my NHS trust won’t approve rifaximin, it varies so much across the country. I have now changed to nifedipine, so will try it with the next lot of antibiotics & see what happens!.

[OldTed60]

Hi - I’ve just been diagnosed with SIBO and am on 3g Mycophenolate, Losartan, Iloprost and many other meds. I’ve just completed my first course of Rifaximin and wasn’t told I had to stop any medications - and I did ask. The one that concerns me most is PPI, esomeprazole - which I believe is one of the causes of SIBO. I asked my gastro as I’m 59 with Gastroparesis (also take Ensure plus and keep to low fodmap diet) and osteopenia. She said as long as I keep up with an Ensure daily (prefers I drink 2 but can’t manage that) and take prescribed D3 daily this should be okay. Never even occurred to me to stop Mycophenolate and I was prescribed Rifaximin last week by the hospital pharmacy who has a list of all my repeat prescription meds.

[Loobyloo12 in reply to OldTed60]

Thanks for your reply. My Rheumatologist has told me in the past to stop methotrexate while on antibiotics ( to do with absorption I think). However, if I now have to have continuing antibiotics I will have to keep taking it & also nifedipine. I will talk to my Rheumy when I see him shortly. The problem I had with the amlodipine was that in the middle of the night I had a crushing pain in my chest & extremely dizzy ( thought I was having heart attack!). Called 111 etc. It had lowered my BP too much as antibiotics can increase the dose of BP drugs, so consequently I’m now very nervous about these things. The joys of scleroderma!!!.

[HowNowWhatNow]

I wonder if you will see my response to your very old question, which I came across when researching Nifedipine side effects.

I wanted to ask… did your GI doctor consider whether your existing meds might be causing you to have SIBO?

GI side effects are known to result from nifedipine, for example.

[Loobyloo12 in reply to HowNowWhatNow]

Thank you for your question regarding nifedipine. Actually I had sibo before starting nifedipine, the sibo is mainly caused through slow motility, causing bacteria to build in the GI tract. But that was a good question. I seem to be managing it successfully at the moment with low fodmap & gluten free under care of NHS dietitian.

[HowNowWhatNow in reply to Loobyloo12]

Thank you.

I also had SIBO first. Following a couple of courses of antibiotics for what doctors thought were UTIs .. but turned out not to be… which would have wiped out my gut microbiome very effectively.

Did you ever have H Pylori? I had that before all of this, too.

Am glad to hear you can manage your gut motility through diet - I tried the low FodMap diet at the start of the year and found I felt great on it. I put it down to sugar (lack of) but it’s not an easy diet to stick to - respect to you for doing so.