Anyone tried Rifaximin?

[Michael_V]

Lots of discussion on this forum about the connection between rosacea and gut bacteria, and surely many here are aware of this article

Small Intestinal Bacterial Overgrowth in Rosacea: Clinical Effectiveness of Its Eradication ,Clin Gastroenterol Hepatol. 2008 May 2, Parodi A, Paolino S, Greco A, Drago F, Mansi C, Rebora A, Parodi AU, Savarino V

stating that in 96% of those rosaceans who were shown to have SIBO (using fermentation tests), eradication of the overgrowth resulted in clearance of their rosacea symptoms. Of those that subsequently relapsed at nine months, all had recurrence of their SIBO. Eradication of that recurrence again led to remission of their rosacea.

The study called for 400mg of Rifaximin three times daily for ten days. Just wondering if anyone here has given it a go? Either without or with a fermentation test? And what was your experience?

[Mistica]

Hi Michael,

Here is the link you want to read.

http://www.rosaceagroup.org/The_Rosa...ad.php?t=13631

It is a long thread and I haven't read it all, but if you looking for recent experiments skip to the last few pages. One man had a delayed success and others are currently dosing.
One man also had success with a different approach.

Rifaximin is not available my side of the world, alas.

[Stphn]

Very interesting. Still, what causes the presence of this bacteria in Rosaceans?

It seems that this too, is but a temporary fix for rosacea; because whatever is causing the presence of the bacteria is a problem yet to solved.

Seems like this is a bit like tracing an electrical problem in a car.
If we only had a 'test-lite' for the human body.

[Mistica]

Originally Posted by Stphn

Very interesting. Still, what causes the presence of this bacteria in Rosaceans?

It seems that this too, is but a temporary fix for rosacea; because whatever is causing the presence of the bacteria is a problem yet to solved.

Seems like this is a bit like tracing an electrical problem in a car.
If we only had a 'test-lite' for the human body.

Our immune systems should be able to deal with pathogens. Seeing it can't, this suggests the immune is not functioning properly.
I would suspect that those who can repair their gut and raise their vitamin D levels to optimal levels should expect longer remission following dosing with rifaximin. Perhaps complete remission. (Cryptic bacteria in the facial tissues as well as in the gut being treated at the same time by D).

Seeing those who have undergone complete bowel irrigations in preparation for colonoscopies often report a temporary calming of the face, it would seem hopeful that undergoing such a 'clean out' prior to the rifaximin therapy might increase benefits.

[Michael_V]

Originally Posted by Stphn

Very interesting. Still, what causes the presence of this bacteria in Rosaceans?

I think the limited research suggests it's the other way around. Some people get overgrowth of small bowel bacteria, possibly but not necessarily due to an immune dysfunction but more likely related to their overall health, the kinds of foods eaten, and/or medications like antibiotics. Some of those people with bacterial overgrowth develop rosacea. In that population, treating the small intestinal bacterial overgrowth (SIBO) eliminates the rosacea.

In that study, almost all of the treated people remained clear at their nine month follow-up. Those that didn't were retested and found to have had recurrence of their SIBO. Treating the SIBO in those people again eliminated their rosacea. So it seems a pretty good case of cause and effect: the bacteria caused rosacea in these people, not the other way around.

Whether or not you or I have rosacea due to SIBO is the next question. If you suspect you might, you can ask your doctor to either order a breath test or prescribe an empirical trial of rifaximin to see if you get better. The kicker, though, is that additional studies have shown that not all SIBO responds to rifaximin, but only the most common H2 producing kind. Other people with SIBO sometimes have CH4 producing bacteria instead, which respond to metronidazole. Something to keep in mind if you go the rifaximin route and don't get better.

If neither works, SIBO wasn't your problem.

[Michael_V]

Originally Posted by Mistica

Our immune systems should be able to deal with pathogens. Seeing it can't, this suggests the immune is not functioning properly.
I would suspect that those who can repair their gut and raise their vitamin D levels to optimal levels should expect longer remission following dosing with rifaximin. Perhaps complete remission. (Cryptic bacteria in the facial tissues as well as in the gut being treated at the same time by D).

Hi, Mistica!

I agree that our immune systems should be able to deal with pathogens, but I am not sure 21st century humankind treats the body the way it spent hundreds of thousands of years evolving to be treated. Our lifestyle, diet, and medication/chemical/hormonal exposures are nothing like Paleolithic man saw. So we have the bodies (and immune systems) of hunter-gathers but do not live in their environment or eat their diet.

As an aside, the other day I read about surviving populations of "primitive" Paleolithic-like populations (such as some tribes in Papua New Guinea). No rosacea and no acne. Not on a single face. Interesting.

Anyway, not yet sure how I feel about cryptogenic bacteria. The idea is gaining support. Biofilms and so on. Think we have enough information to productively deal with the bacteria we already know about, so in my opinion that is a better place to start, but I am open to learning.

We have been discussing the role of vitamin D in detail in the "Pathogenesis" thread. Come on over!

[Michael_V]

Well, I just finished a 10 day course of rifaximin at the study dosage (400mg tid). So far, my p&ps are if anything worse.

So, of the "curable" causes of rosacea that I know of (cessation of PDE5 inhibitors, demodex eradication, and treatment for SIBO), I am zero for three.

[Mistica]

Originally Posted by Michael_V

Well, I just finished a 10 day course of rifaximin at the study dosage (400mg tid). So far, my p&ps are if anything worse.

So, of the "curable" causes of rosacea that I know of (cessation of PDE5 inhibitors, demodex eradication, and treatment for SIBO), I am zero for three.

That is a shame. Maybe you might be lucky enough to experience a delayed improvement as did one of the posters here. He too, thought his experiment was a failure initially.

I see you have tried oral ivermectin.
It has been established that the oral method is not effective, hence the reason a topical form was used in the trial here.
Seeing you are a physician I wonder if you have the powers to lay your hands on some ivermectin and have it compounded into topical form?
The trial used 1%. I believe the penetration enhancer was Propylene Glycol. It was in mine anyway.

[Seth]

Originally Posted by Michael_V

Well, I just finished a 10 day course of rifaximin at the study dosage (400mg tid). So far, my p&ps are if anything worse.

So, of the "curable" causes of rosacea that I know of (cessation of PDE5 inhibitors, demodex eradication, and treatment for SIBO), I am zero for three.

Michael,

Just out of interest, do you suffer any digestive ailments? As a very rough rule of thumb, it would seem that if a person suffers constipation predominant IBS-like symptoms it would be more suggestive of overgrowth of methane producing bacteria and therefore probably will not be responsive to rifaximin. Of course, a breath test will be the gold standard of determining this though. And as Mistica says, you should probably give it a few weeks before being certain the treatment was unsuccessful.

[Michael_V]

Originally Posted by Seth

Michael,

Just out of interest, do you suffer any digestive ailments? As a very rough rule of thumb, it would seem that if a person suffers constipation predominant IBS-like symptoms it would be more suggestive of overgrowth of methane producing bacteria and therefore probably will not be responsive to rifaximin. Of course, a breath test will be the gold standard of determining this though. And as Mistica says, you should probably give it a few weeks before being certain the treatment was unsuccessful.

No, no real digestive symptoms. Methane producing bacteria remain a possibility, though not too long ago I was treated with metronidazole for two weeks, which should have at least thinned their populations out a bit.

I will be watchfully waiting but am exactly not holding my breath.

Oh, speaking of breath ... I asked a gastroenterologist friend about doing breath tests prior to rifaximin, and his opinion was that the tests were not particularly good, so he preferred just giving the drugs a go and seeing what happens.

I will keep you guys posted if I miraculously improve. Fingers crossed!