SIBO and Low-Dose Erythromycin

[KPM]

Hi all,

I recovered from CDiff in 2019. This group was very helpful and supportive.
Last year, unfortunately, I got SIBO, and it's been very hard to beat. I did two rounds of Rifaximin, which did not work (did not get Cdiff again, though). The SIBO has come with horrible nausea and decreased appetite, and I have lost too much weight, and my life has become untenable.
I went to see a new GI today and he prescribed low-dose erythromycin for gastric emptying - he said it's very unlikely to get Cdiff from a low daily dose, but not impossible. I asked if there was any other treatment he could think of, and he said this was the best one.

I'm wondering if anyone on here who has recovered from Cdiff knows anything about low-dose erythromycin. I have found it very difficult to find much about it online.

Thanks so much.

[Ril]

Hello KPM and welcome to the site. Please read the first section on rules for posting for new members.

I have not heard of erythromycin for SIBO. Delayed gastric emptying with nausea , early fullness (satiety), appetite loss and weight loss, sounds like gastroparesis and low dose erythromycin is one of the meds that is prescribed for that. Are you sure your GI didn’t diagnose you with that? There are tests…gastric emptying test…to confirm that, and other medications that can treat that as well if that is what you do have.

I cannot give medical advice but am just suggesting you be sure of the diagnosis before you decide on what medications to take and if you are uncomfortable you can always go for a second opinion.

Good luck and feel better.
Rita

[KPM]

Thanks, Rita. I have SIBO (diagnosed through a breath test) but this new doctor believes that one of the underlying causes is slowed motility. I did have a gastric emptying test, and it was negative, but he still believes I have some element of gastroparesis. Low-dose erythromycin is often prescribed as a prokinetic for SIBO patients, since a lot of SIBO patients have slowed motility. This is the 5th GI I have gone to for this. No one seems to be helping much. :( I'm seeing a naturopath now, as well.

I guess my main question was whether or not a low-dose of erythromycin (he's suggesting 50mg 4X/day) could bring on Cdiff. He said it's unlikely but I do have concerns. Unfortunately my symptoms have been so awful - even worse than when I was sick with Cdiff! - that I'm getting desperate.

Thanks for your reply, and if you know anything about the relationship between low-dose ER and cdiff recurrence, please let me know.

Best,
Karen

[Ril]

If you go to the section on the site for questions about c diff, you will find a list of antibiotics and which are high offenders and which are least likely to cause c diff. Erythromycin is least likely (low offender) to cause c diff and relatively safe….but that said, no antibiotic is totally safe especially used long term. It comes down to a risk/reward situation so you have to make that decision especially considering your emptying time was normal. I would personally use probiotics especially Florastor along with any antibiotic. And there are also other prokinetic agents but they too have risks although not c diff. I am sure you will have a discussion with your dr and decide what is best for you. I understand why this is such a difficult decision.

This is a c diff site and we are not supposed to give medical advice but I must say since your case seems to be so complicated there are SIBO experts and I would research one if you haven’t already and try to get a telehealth appointment if they are not local. If that is not an option hopefully the treatment you decide upon brings you relief.