Hi everyone. I am new to this group. I have IMO (formally methane SIBO). I am an engineer by training (hospital based) and have extensive experiencing reviewing medical literature. I recently completed a 2 week course of rifaximin and neomycin without success (actually a little worse)
Because of my experience I was motivated to take a deep dive into the available literature of conventional medicine treatment guidelines to try to make sense of the treatment options. I used the american gastroenterological association (AGA) guidelines. I have not taken a deep dive into the alteratives, e.g., herbals. Below is my personal take on what is known and what is not.
As a general note much of the guidelines are based on a very small number of clinical studies and leave a lot to be desired for quality and interpretation.
For starters the AGA does recommend rifaximin/neomycin in combination for people who test positive for IMO on standardized breath tests. The duration (usually 2 weeks) can be extended based on the severity of the test results. The addition of neomycin to the protocol is based on some fairly small studies that indicate that the two antibiotics can acheive an 85% success rate (based on repeat breath tests) compared to only about a 30% success rate for rifaximin alone. The studies do not address the number of people who will achieve normal breath tests, but will require additional treatments. The number of people who require repeat treatments is much more difficult to source, but it seems to be between 40-60%. In the real world most people who relapse, or failed the initial course of treatment, do not receive a follow-up breath test which is in accordance with AGA guidelines. The bottom line is that it is virtually impossible based on available information to make a a solid informed decision about the efficacy of these treatment protocols in my opinion. As for neomycin side effect concerns, that is even murkier. As far as I can ascertain there are only two small study demonstrating the ototoxicity for orally administered neomycin. One study involves children, the other adults. The adult study included 30 subjects, two of whom developed hearing loss (6.6%). Virtually all of the other information documenting ototoxicty from neomycin is from studies where neomycin was administered either I.V. or topically. In those studies, pre-existing hearing loss and age seem to increase the chances of neomycin induced hearing loss. The AGA says 95% of neomycin is confined to the GI tract. I have no idea what to conclude from that number on how it correlates to the information from the above mentioned studies.
I recently purchased a home breath test analyzer from a company called foodmarble (aire2). This analyzer measures both methane and hydrogen. I do not know how well this device compares to the clinical devices used in hospitals and other settings. I purchased the device to begin to collect data on my own scores and see if I can track how effective my own interventions are, e.g., diet, supplements, etc. The manufacturer has data that as far as I know is not publicly available (hopefully some day).
My conclusion is that the treatment of IMO is based on a very small and inclusive body of information and that additional clinical trails are desperately needed. I have searched online for ongoing clinical trials and there does not seem to much going on in this area as best as I can tell.
That's my conclusion. I would love to get some reactions and thoughts.