Abstract
Small intestinal bacterial overgrowth (SIBO) is often secondary to intestinal dysmotility and several other predisposing conditions. Treatment of SIBO typically includes antibiotics and treatment of underlying etiology. Identification and treatment of the underlying modifiable causes is critical for management of refractory and recurrent SIBO. We report here a case of scleroderma with small bowel dysmotility and bacterial overgrowth, on different occasions the patient failed to respond to Rifaximin. We showed that restoring small bowel motility is critical in maintaining the effectiveness of Rifaximin in the treatment of SIBO. Rifaximin resistance may also develop following prolonged use of antibiotics. Rotation of antibiotic regimen is important to prevent drug resistance.
Highlights
Small intestinal bacterial overgrowth (SIBO) is characterized by excessive bacteria in the small intestine
We report a challenging case of recurrent and refractory SIBO associated with scleroderma where identification and treatment of the underlying small bowel motility disorder is critical
Our patient ailed to respond to Rifaximin, one of the most commonly used antibiotics for SIBO
Summary
Small intestinal bacterial overgrowth (SIBO) is characterized by excessive bacteria in the small intestine. Octreotide was continued and rifaximin therapy was extended on a 2-week on, 2-week periodic basis to prevent the recurrence of SIBO and the development of bacterial resistance Her GI symptoms of nausea, abdominal pain and bloating returned 6 weeks later. A repeat glucose HBT showed a hydrogen peak of 110 ppm at 45 minutes after glucose administration suggesting recurrence of SIBO, most likely die to the development of resistance to Rifaximin, Antibiotic therapy was changed from Rifaximin to a combination of Metronidazole 500 mg b.i.d. and Neomycin 500 mg b.i.d. Glucose BHT at 1 week after the switch of antibiotics was negative, indicating successful eradication of SIBO. Glucose BHT at 1 week after the switch of antibiotics was negative, indicating successful eradication of SIBO Her GI symptoms once again improved, and the rate of enteral feeding was increased to 90 cc/hour. Enteral feeding was increased to 110 ml. hour providing 1700 calories per day, Glucose HBT continued to be normal, indicating SIBO was well controlled with Metronidazole/ Neomycin combination
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