What Are Some Less Expensive Options For Xifaxan To Treat SIBO?
In our latest question and answer, the pharmacist discusses some alternative, less expensive options, to Xifaxan for treating SIBO.
I recently took a breath test and was found to have an abnormal level of methane gas. My doctor prescribed rifaximin, but the price is something I cannot afford. Is there something compatible that is more within my budget? Thank you.
Aug 10, 2023- Rifaximin is the most effective antibiotic for SIBO but costs significantly more than alternatives like trimethoprim-sulfamethoxazole, norfloxacin, ciprofloxacin, metronidazole, tetracycline, and amoxicillin-clavulanic acid. Less expensive alternatives can still be effective for treating SIBO even though they don't have the same level of evidence as rifaximin. Your doctor can help you choose an affordable antibiotic option based on your specific situation and any allergies you may have.
Quick Answer
If the cost of rifaximin is too high for you, there are more affordable options available, such as trimethoprim-sulfamethoxazole, norfloxacin, ciprofloxacin, metronidazole, tetracycline, or amoxicillin-clavulanic acid.
Detailed Answer
It's not entirely clear in your question, but it seems that your doctor diagnosed you with SIBO (small intestinal bacterial overgrowth) based on your mention of an abnormal amount of methane gas in a lab test.
What Is SIBO & How Is It Diagnosed?
Small intestinal bacterial overgrowth (SIBO) is a condition where there are an excessive number of bacteria in your small bowel. People with SIBO typically experience symptoms such as bloating, gas, belly pain, or diarrhea.
In some cases of SIBO, an excess of methane gas is produced, which is referred to as intestinal methanogen overgrowth (IMO).
The diagnosis of SIBO is confirmed through a carbohydrate breath test or a test to find a high bacterial concentration in a jejunal aspirate culture. The carbohydrate breath test is usually the initial step due to its simplicity and non-invasive nature.
Antibiotic Choices
The primary treatment for SIBO involves antibiotics that reduce, but not necessarily eliminate, the population of small intestinal bacteria.
Antibiotic therapy typically commences after a positive breath test. This process takes into account various factors such as the pattern and extent of bacterial overgrowth, risks of antibiotic resistance, potential allergic reactions, and cost-effectiveness.
The therapy usually involves Xifaxan (rifaximin), the drug you mentioned in your question, which is a non-absorptive rifamycin derivative that is well-tolerated and effective in managing SIBO. However, due to its high cost, alternatives are often considered. This is the situation you described.
Before moving forward, I want to mention that for patients specifically diagnosed with Intestinal Methanogen Overgrowth, a combination therapy of neomycin and rifaximin is often utilized and has the strongest evidence of benefit.
Nevertheless, even though rifaximin has demonstrated superior effectiveness against SIBO compared to its alternatives, its high-cost drives individuals to consider more affordable options, such as:
- Trimethoprim-sulfamethoxazole
- Norfloxacin
- Ciprofloxacin
- Metronidazole
- Tetracycline
- Amoxicillin-clavulanic acid
As mentioned, these antibiotics do not have the same level of evidence for benefit as rifaximin does, but they can still be effective. All of these antibiotics are significantly less expensive than rifaximin.
Below is a chart that lists antibiotics used for treating SIBO.
| Oral antibiotic therapy | Adult dose | Pediatric dose | Notes |
|---|---|---|---|
| Rifaximin | 550 mg three times daily | Children 3 to 11 years: 200 mg three times daily | Most effective option Low systemic absorption High-cost relative to other options |
| Trimethoprim-sulfamethoxazole (TMP-SMX) | 160/800 mg twice daily | 4 to 5 mg/kg of trimethoprim component per dose twice daily | Low cost Caution with sulfa allergy |
| Ciprofloxacin | 500 mg twice daily | 10 to 20 mg/kg per dose twice daily | Routine use in children avoided due to potential risk of musculoskeletal toxicity (usually mild) |
| Amoxicillin-clavulanate | 875 mg twice per day | 25 to 30 mg/kg per day (amoxicillin component) in two or three divided doses | Generic Augmentin |
| Metronidazole | 250 mg three times per day | 10 mg/kg per dose twice daily | Generic Flagyl |
| Doxycycline | 100 mg once daily to twice per day | Children ≥8 years and >45 kg: Refer to adult dosing Children <8 years: Not recommended |
Less risk of dental staining in children with short course versus tetracycline. |
| Tetracycline | 250 mg four times per day | Children ≥8 years: 10 to 15 mg/kg per dose three times daily Children <8 years: Not recommended | Use in children <8 years old avoided due to risk of permanent tooth discoloration. |
Final Words
Thank you for reaching out to us, and please feel free to contact us again anytime.
References & sources
Glossary — Terms in This Answer
- SIBO
- Small intestinal bacterial overgrowth, a condition where excessive bacteria accumulate in the small bowel.
- Methane gas
- A gas produced by bacteria in the intestines that can be measured in breath tests to diagnose certain digestive conditions.
- Intestinal methanogen overgrowth (IMO)
- A type of SIBO characterized by excessive production of methane gas in the small intestine.
- Carbohydrate breath test
- A non-invasive diagnostic test that measures gases in the breath to detect bacterial overgrowth in the small intestine.
- Jejunal aspirate culture
- A test where fluid is sampled from the small intestine to check for high concentrations of bacteria.
- Rifamycin derivative
- A type of antibiotic drug that is related to rifamycin, a substance used to kill bacteria.
- Non-absorptive
- A property of a medication that means it stays in the digestive tract rather than being taken into the bloodstream.
- Systemic absorption
- The process by which a medication enters the bloodstream and is distributed throughout the body.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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