Rifaximin (Xifaxan) is a prescription antibiotic that is minimally absorbed, thereby retained in the gastrointestinal (GI) tract. It has a broad spectrum of action against numerous bacterial species by blocking bacterial protein production. Based on the pioneering work of UCLA/Cedar-Sinai gastroenterologist, Dr. Mark Pimentel, and others, rifaximin has become the antibiotic of choice in treating small intestinal bacterial overgrowth. Rifaximin is effective in killing a broad range of species that dominate in SIBO such as Staphylococcus, Enterococcus, and Gram-negative fecal microbes.

The use of rifaximin in conventional circles is increasing for applications outside of SIBO. New indications include:

  • IBS-D—i.e., irritable bowel syndrome with diarrhea
  • Rosacea—In one human clinical trial, 96% of participants experienced marked reduction in rosacea skin rashes with rifaximin. Participants who experienced relapses proved to have SIBO and once again responded to rifaximin.
  • Diverticular disease—Preliminary evidence suggests that there are fewer recurrences after rifaximin vs. placebo in people with a history of diverticulitis.
  • Inflammatory bowel disease—Preliminary evidence suggests a favorable role for rifaximin in ulcerative colitis with around 67% of people achieving remission after rifaximin, and in Crohn’s with 52-70% achieving remission.
  • Hepatic encephalopathy—The impaired mental function that occurs in people with liver disease improves with rifaximin.

We also know, with fairly abundant evidence, that rifaximin is moderately effective in eradicating SIBO. In addition to responding to rifaximin, all the conditions listed above have also been shown to be accompanied by SIBO in the majority. Is there any way to avoid the conclusion that ALL the above conditions are therefore synonymous with SIBO? After all, In other words, regardless of the label of “rosacea” or “IBS-D” or “diverticular disease,” it’s virtually all SIBO.

Please do not interpret this discussion as encouragement to take rifaximin. I believe that there are more rational ways to deal with the dysbiosis or SIBO that drive these conditions, as well as the endotoxemia that accompany such microbial disruptions. For instance, we have been using what I call “SIBO Yogurt,” a collection of microbial species/strains that colonize the upper GI tract where SIBO occurs and produce bacteriocins effective against the species of SIBO. We have been witnessing around 90% success with this strategy, as judged by normalization of breath hydrogen gas via the AIRE device. The recipe for SIBO Yogurt is in my Super Gut book. We are planning a formal clinical trial to validate this practice in future.