Chronic fluoroquinolone (FQ) toxicity, (FQAD), or chronic floxing is a multi-factorial process. FQ’s have the ability to initiate a whole host of negative processes that in-turn put into motion the machinery that can result in chronic health issues. One of these culprits that is often overlooked in chronic FQ toxicity is small intestinal bacterial overgrowth, or SIBO.
SIBO can become an issue for a chronic floxies through several mechanisms, I will address just a couple.
The Microbiome
First the FQ’s can damage parts of the nervous system that control digestive tract motility. This can run the gamut from improper stomach emptying (gastroparesis) to intestinal movement (peristalsis) issues.
The ideal bacterial balance in our intestines relies on numerous factors. One of the key factors for maintaining intestinal bacterial balance is peristalsis. Peristalsis is the
involuntary constriction and relaxation of the muscles controlling intestinal movement. It is coordinated or regulated by the body’s nervous system to move the food through the digestive system. When this wavelike pattern becomes disrupted, bacteria can move up into areas where it they are not supposed to be causing chronic symptoms, sometimes these symptoms can be quite debilitating.
Secondly, the FQs obliterate the microbiome. In other words, FQ’s act like a nuclear bomb wiping out whole colonies of bacteria. Many of these bacteria colonies are friendly bacteria that are tied uniquely to you. When these colonies get wiped out they may get replaced by bacteria that are not so friendly for your body.
From personal research I have learned that there are about 1000 different strains of microflora that could end up populating your gut. Most individuals are inoculated with around 150 core strains (not including subspecies) of this larger pool. This inoculation occurs during the birthing process.
This bacterial cocktail become unique to you over time and some experts believe these colonies of ‘probiotics’ become about as unique as your fingerprints. It is theorized that this adaptation happens when DNA in the bacteria mutate to link to the environment in your colon. More simply, they adapt to you in order to survive by providing you with nutrients that in-turn insure their survival in a true symbiotic relationship.
Viewing our gut microbiome this way, one can understand how devastating antibiotic use, especially FQ usage, can be to the overall health of an individual. Also using this perspective, one can see that, even though some bacteria are considered good ‘probiotics’, they may not be ‘good’ for you as they lack the history of being ‘seeded’ by mother and then subsequently mutating to your environment.
Now, there are some ‘safe’ strains of probiotics that scientists believe that have a high percentage of cross population in humans but there are clearly those that do not. The debate rages on whether once your original microbiome becomes obliterated is it possible to ever completely recover ideal gut functioning?
Obviously, this is some of the thinking behind fecal transplants and why, according to what I have read, those transplants from siblings have a higher success rate even over cohabitants like spouses. This original microbiome encompasses all aspects of bodily assimilation.
Pamela’s SIBO Story
So what does happen in some cases of chronic floxing? Enter Pamela; her name has been changed for anonymity. Pamela is a chronic floxy having been floxed many 
years ago. She went on to develop several debilitating conditions, one of which was Chronic Fatigue.
On a side note, Pamela recently relayed her story to me about SIBO after I reached out to her about it. I maintain contact with many chronic floxies and track their progress over time gathering data on what helps and what does not.
Over the last several years Pamela’s digestive health became worse and worse and eventually lead to a diagnosis of gastroparesis through a test called gastric acid scintigraphy. Life for Pamela was pretty miserable like it is for most chronic foxies. Besides having chronic fatigue, she suffered from bouts of stomach pain, nausea, cramping, and alternative bouts of IBS diarrhea and constipation.
Not being able to handle the digestive distress anymore she sought help from gastroenterologist who eventually diagnosed her with SIBO. Like I mentioned earlier in this article, SIBO can easily come about because of gastroparesis. The doctor wanted her to take a new antibiotic called Xifaxan.
Pamela, like most FQ toxicity sufferers, was fearful of taking any antibiotic so she took the script home and did not fill it. However her symptoms continued to worsen and out of desperation she went to have the script filled only to find out that her insurance would not cover it.
Xifaxan has been approved by the FDA for traveller’s diarrhea and IBS-D. Xifaxan is very expensive with the cost for the larger dosage running as high as thirty three dollars per pill. Since Pamela also had IBS-D, her doctor was eventually able to help her get partial coverage from her insurance company and she was able to get a discount card through the pharmaceutical company to cover the remaining amount.
Pamela told me that without both the partial coverage from insurance and the discount card she would not have been able to afford it since a script for 10 days ran upwards of a whopping $1200 dollars!
Pamela told me that she read about Xifaxan extensively. What she read comforted her, along with reassurances from her gastroenterologist, that Xifaxan was safe. Xifaxan is a unique antibiotic that is poorly absorbed. In other words, it remains primarily in the intestinal tract where it does the job of killing pathogens. It is not invasive like the FQ’s.
Pamela relates her story about what happened next. “I started taking the Xifaxan three times a day. Each tablet was 550 mg and quite large in size. The first thing I noticed is that within 24 hours my inner bowel settled down tremendously. The grumbling and rumbling noises that I had in my inner bowel all day and night diminished drastically.
The first two days I felt like I was catching a cold and also had a slight headache but overall I was pleased that my digestive distress had diminished greatly. On the fifth day something wonderful happened.
I had been plagued with chronic fatigue since my third year post floxing. Most days for me I was either chair or couch bound. I had been very depressed since my fatigue and joint pain had mostly disabled me. On the fifth day, the fatigue lifted tremendously. At first I thought it was fluke, but after a bit I realized this was the real deal.
My brain fog lifted and I regain enough energy to leave the house and go shopping; that in and of itself was a monumental achievement. I was honestly shocked. I kinda half expected to help my gut, but I did not expect it to help my energy. The muscles in my chest had more energy and I was able to breathe more fully again.
Looking back it now makes sense since I was plagued by SIBO. Some doctors say that SIBO can cause all sorts of problems including neurological and definitely chronic fatigue. I believe the toxins from the bacteria were overloading my system.
My doctor and I are still trying to figure out what to do long term, since I know the SIBO is a chronic complication of gastroparesis. I cannot afford to take the XIfaxan all the time, but I may have to figure out a way to pulse dose it.”
Is Pamela cured? No, however it gave her hope and an improvement in some of symptoms. She now has a concrete avenue to explore that hopefully will give her some improvement in her overall quality of life.
SIBO Is Tough To Overcome
Dr. Amy Nett
Amy Nett, MD says that “studies show that despite treatment with antibiotics, recurrence develops in almost half of all patients within one year. One study comparing treatment with rifaximin (the most commonly used antibiotic for SIBO) and botanical antimicrobials showed slightly better outcomes with the botanical protocol, but still with successful treatment in close to only half of all patients after one course of treatment. This finding suggests that patients with SIBO, who do not recover after a standard course of antibiotics, or botanical antimicrobial protocol, may benefit from the addition of a prokinetic agent, which increases the muscular contractions of the small bowel. Octreotide and low dose naltrexone are two such options that are being investigated, and may help treat some cases of SIBO that don’t respond to antimicrobials alone.”
Does everyone who has chronic FQ toxicity have SIBO? Probably not, but it could be a contributory factory in the poor health of many chronic floxies.
Some people believe that in long term FQ reactions (not to mention other health conditions as well), where chronicity has set in, along with other co-morbid conditions such as chronic fatigue, fibromyalgia, etc…, the gut microbiome has been irreparably harmed which in turn alters gene expression and so on.
In addition, bacterial dysbiosis and all of its collateral associations are now being linked to virtually every aspect of our metabolism ranging from neurological, hormonal, neurotransmitters, and more, including even tendons. Dysbiosis causes micro inflammation and oxidative stress. Both of which have tremendous ability to harm.
The moral of this story is, don’t give up hope. It is a tough battle, I know, I live it daily. I do not like false hope and prefer the truth, no matter how difficult. However, after many years we can lose hope, and back ourselves into a blind alley thinking that there is nothing else that can be done. This story goes to show us that sometimes help comes from unexpected sources. Sometimes there are things that we can do that will to improve functioning by 20, 30, or 40 % and make life more functional. Never give up.
“Some things are so unexpected that no one is prepared for them.” Leo Calvin Rosten – American humorist.
Thank you for posting this story. My husband was floxed January 2010. We’ve been trying to figure out how to deal with the digestive problems, food allergies, and chronic fatigue. His symptoms are very similar to Pamela’s. We will now pursue this with a gastroenterologist. I’ll keep you posted. Keeping fingers crossed this could be the needle in the haystack we’ve been searching for all these years.
Prior to my ADR to cipro I was diagnosed with SIBO. I suffered from constipation for years and it also gave me acid reflux. The SIBO gave me dry skin and dandruff amougst other things too. Xifaxan has been shown to improve people with rosacea. I took Xifaxan and it worked for a few weeks. I also tried vivonex treatment which worked for a little longer but it’s hell. My gastric emptying test was borderline normal.
After my ADR to Cipro my gut did the opposite of many people. It speeded up and my constipation went away. I not longer had horrible dandruff and some of the other symptoms. Obviously I’d kill to be back before my cipro and suffering with SIBO alone.
For the record I had no adverse reaction to Xifaxan prior to my ADR to Cipro.
Thanks for the info Andy.
I don’t exactly know why I have chronic fatigue syndrome, arthritis, etc. Not because of quinolones because I never took them but maybe some other antibiotics did the job or maybe some of the substances that I had contact with since I was a child and when I was adult too. Anyway I was considering sibo as a cause of problems too but never got to the phase when an antibiotic for it is prescribed – simply the sibo breath test came out negative – but there are different problems with this test too, they tested me for one gas (hydrogen AFAIR) but the bacteria may produce some other (methane, hydrogen sulfide).
And about two weeks ago I got simple amoxicilin for my strep throat.
First my stomach problems got worse (terrible cramps, a nightmare) but now it looks like they got much much better than before. Also simethicone seems to help and as I read in some research papers not only does it have gas releasing properties but also some antibacterial properties. No matter the mechanism, it works.
Conclusion: you may not need rifaximin, any antibiotic will do even one that is absorbed from the gut but it would be good if it had the same antimicrobial profile as rifaximin.
If you find one fullfilling this criteria then it’s only a matter of finding a doctor who would prescribe you it.
On the other hand: is you situation bad enough for you to go all the way and experiment with antibiotics and off-label use. Mine is. Also remember that rifaximin makers specifically made such a label use for their product and set such a high price that their enormous salaries are paid… but that’s a whole different story…
Mick, Thanks for weighing in. I agree that repeated insults to the microbiome cause many of the health problems that we see today. The question “Can we regain what we had, once it’s lost?” I truly doubt it when it comes to our microbiome, at least for now. I am glad that some people can find relief of their symptoms. Sometimes relief comes from an unexpected direction. I hope that your relief lasts.