Hey all,
I finally got rifaximin approved (miracle), and my GI gave me the option of pairing it with either neomycin or metronidazole for methane-positive SIBO.
From what I’ve read, Dr. Pimentel’s research suggests rifaximin + neomycin tends to be more effective for methane cases compared to rifaximin alone, and possibly better than other combos. That said, I’m honestly pretty anxious about the side effect profiles:
- Neomycin → ototoxicity (hearing loss risk), kidney concerns
- Metronidazole → neuro sides, weird systemic effects, alcohol restriction, etc.
My kidney labs are normal, and this would just be a short course, but the idea of anything even remotely tied to hearing damage freaks me out.
At the same time, I don’t want to go through this whole process, finally get rifaximin covered, and then half-measure the treatment and increase the chance of relapse or failure.
So I’m trying to balance:
- Effectiveness (especially for methane)
- Side effect risk (real-world, not just worst-case warnings)
- Your actual experiences on either combo
Questions:
If you’ve done rifaximin + neomycin, how was it? Any side effects? I’m terrified of tinnitus and hearing loss.
Same for rifaximin + metronidazole?
Did one feel more effective for methane symptoms?
If you had to choose again, would you make the same choice?
Would really appreciate grounded input — not just “this drug is scary,” but how it actually played out for you.
Thanks