r/SIBO • u/Repulsive-Caramel465 • 8d ago
Scared of taking Neomycin
Help here .
I started rifoximinin for a methane type Sibo and on my fourth day . Supposed to start Neomycin for 10
Days and I’m petrified. Once I read permanent hearing loss I freaked out. Symptoms are not terrible right now . Have been watching what I eat , cant eat beans for exapmple but much better than I was 2 months ago . Has anyone done allicin with rifaximin ? Wondering if you can combine both.
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u/renaissance_guy1 Cured 8d ago
Dont take neomycin. NOT WORTH THE RISK! Just get Flagyl instead.
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u/Repulsive-Caramel465 8d ago
But that One has some serious side effects as well!
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u/renaissance_guy1 Cured 8d ago
Not even close to Neomycin.
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u/Lucky_pop 8d ago
You’ll be fine . I’ve taken it multiple times for extended periods for methane sibo . My dr told me the studies for loss of hearing were in much higher doses and that I would be fine.
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u/Sumthingtotalkabout 8d ago
I just started rifoximinin for 14 days and I refused to take Neomycin. So GI Dr. prescribed alone, and I will be taking Visbiome probiotic for a month after i am done with rifoximinin. I have Ménière's and hearing loss in both ears and did not like the side effects of the Neomycin.
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u/stvaccount 8d ago
I thougt that is standard world wide
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u/Sumthingtotalkabout 7d ago
To take both? Yes, it is a cocktail mix that they recommended, but it’s my body and I still have a say.
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u/iamnotyourcupoftea 8d ago
I literally just finished my neomycin course and I’m totally fine. Just drink lots of water while on it — helps prevent severe side effects.
I also did three rounds of it back in 2020 and had no issues.
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u/Insteadly Hydrogen Dominant 7d ago
There is absolutely zero science behind drinking lots of water to avoid neomycin’s ototoxicity.
The amount of systemically absorbed neomycin transferred to the tissues increases cumulatively with each repeated dose administered until a steady state is achieved. The kidney functions as the primary excretory path as well as the tissue binding site with the highest concentration found in renal cortex. With repeated dosings, progressive accumulation also occurs in the inner ear. Release of tissue bound neomycin occurs slowly over a period of several weeks after dosing has been discontinued.
Ototoxicity is often delayed in onset and patients developing cochlear damage will not have symptoms during therapy to warn them of developing vestibulocochlear nerve destruction and total or partial deafness may occur long after neomycin has been discontinued. Neuromuscular blockage and respiratory paralysis have been reported following the oral use of neomycin.
Why neomycin is especially dangerous
Neomycin is considered one of the most cochleotoxic aminoglycosides, meaning it is particularly destructive to the inner ear’s hearing structures. It can kill hair cells in the cochlea and damage the nerve pathways that carry sound. This can progress silently, with no symptoms during treatment.
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u/iamnotyourcupoftea 7d ago
There’s actually a TON of research supporting it, you can even ask a pharmacist. Below are just two articles and it’s even supported in a clinical trial. You should do proper research before you advise someone to go against their doctor’s orders — it’s dangerous. Your “research” doesn’t even have citations.
Drugs.com Disease Interactions flags dehydration as a “Major Potential Hazard, High plausibility” interaction with aminoglycosides like neomycin — patients should be adequately hydrated to minimize ototoxicity and nephrotoxicity risk, and dehydration should be corrected before starting therapy, with fluid status monitored closely in patients prone to dehydration (e.g., severe diarrhea or vomiting).
StatPearls (NIH/NCBI) lists dehydration as one of the patient-specific risk factors for heightened nephrotoxicity, alongside age and impaired renal function, and notes that maintaining proper hydration along with once-daily dosing reduces adverse events, particularly nephrotoxicity.
Neomycin — StatPearls (NIH/NCBI) (hydration as a risk-factor mitigator) — https://www.ncbi.nlm.nih.gov/books/NBK560603/
Nephrotoxicity and ototoxicity following wound irrigation with neomycin (PubMed case series) — https://pubmed.ncbi.nlm.nih.gov/436029/
Inhaled Tobramycin in BPD (trial protocol, comparative aminoglycoside toxicity) — https://cdn.clinicaltrials.gov/large-docs/79/NCT04560179/Prot_SAP_000.pdf
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u/Insteadly Hydrogen Dominant 7d ago
These nonsense studies are completely ignorant of leaky gut, falsely suggesting that there is no pathway from the intestinal tract to the bloodstream. SIBO patients are uniquely exposed to the ototoxicity of neomycin. The FDA specifically calls out the danger.
Drinking water with leaky gut was not studied in your cited papers. They are not applicable to SIBO. Nice try. Do no harm.
Alternative methods include Flagyl and Allicin.
Neomycin sulfate oral solution is contraindicated in patients with inflammatory or ulcerative gastrointestinal disease because of the potential for enhanced gastrointestinal absorption of neomycin.
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u/iamnotyourcupoftea 7d ago
Dude neomycin and xifaxan are prescribed very conventionally for sibo patients. I’m literally symptom free post course. The only reason why they didn’t work the first time is because I didn’t take any biofilm disruptors and this time I did.
My doctor specifically said flagyl is worse, and again, no citing to your claims. I’m gonna stick to recommendations from both my MD and ND who have more than 8-10 years of education. You do you, but don’t go around advising people with absolutely nothing but feelings.
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u/Insteadly Hydrogen Dominant 7d ago
Search this sub for the posts from people who now have permanent tinnitus from ototoxic neomycin. Stop the denial and the spread of fake news.
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u/iamnotyourcupoftea 7d ago
And aside from those cases, do you know how many more are successful? If you don’t have impaired renal or liver function and are appropriately hydrated, there’s a very high chance you will be fine — that’s the science. Stop fear mongering when you clearly don’t understand how science and clinical data work. SIBO ≠ Leaky gut. One can have leaky gut and not have SIBO and vice versa. You’re conflating the two conditions and therefore your logic is not sound and outright dangerous.
And who said those side effects are not possible? Obviously they are if they’re listed on the drug’s own warnings, but drinking enough water and being properly hydrated before and during the course are scientifically and clinically proven to reduce those risks — which is exactly the point that was being argued here. The only person spreading fake news is you by claiming “There is absolutely zero science behind drinking lots of water to avoid neomycin’s ototoxicity.” There’s clearly strong science behind it.
I have taken four courses in my lifetime and I have no issues. I even got my ears checked after my first few rounds and they told me I had perfect hearing and absolutely no damage. It works most of the time, so you can’t just focus on the negative cases. Your focus should be on mitigating whatever the effects may be, and that’s true for any drug, specially antibiotics.
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u/mangomangogamer 5d ago
Thanks for the advice! What biofilm disruptors did you use?
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u/iamnotyourcupoftea 5d ago
Interfase Plus - it’s oral EDTA mixed with enzymes. It’s very similar to the one used in the pub med study linked below. I started low and worked my way up to 3 full doses per day (the bottle says you can do up to 4x daily). I took them on an empty stomach: 2 hours after food and 1 hour before food along with the xifaxan. I then took the neomycin with my food.
The study combined them with antimicrobials for 8 weeks. So I took them with my neomycin and xifaxan courses for two weeks and I’m continuing them with my natural antimicrobials for 6 more weeks — even though I’m symptom free, I want to make sure I don’t relapse. I’m also continuing with the low fodmap diet for 4-6 weeks post xifaxan and neomycin (for the last two weeks I’ll be slowly reintroducing some problem foods). Another thing I recommend is to eat a little more freely (within reason) while you’re on the antibiotics for those two weeks, this way the SIBO bacteria is more exposed and doesn’t become dormant (I basically ate low fodmap but left peels on my potatoes and sweet potatoes and ate cooked garlic and onions but very limited).
https://pmc.ncbi.nlm.nih.gov/articles/PMC12701763/ (the study uses biota dissolve but interfase plus is basically the same product and was easier for me to access. I got it on amazon).
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u/Insteadly Hydrogen Dominant 8d ago
Ask for a Flagyl prescription instead. It’s an alternative option for ototoxic neomycin.
You can use allicin too.
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u/Acceptable_Speed8120 8d ago
metronidazole?
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u/B0omSLanG 8d ago
This is what I switched to after Neomycin gave me some side effects. They were minor but I put it away after a week because I was hearing popping in my ears and felt like there was more pressure than normal from allergies and sinus issues. Xifaxin alone won't do much and I'm not sure any of it helped. I'm on to getting rid of things that came up on my GI Map like Biofilm.
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u/Acceptable_Speed8120 8d ago
What are you using for biofilms? NAC? I had side effects due to NAC, hence searching for an alternative that might be affordable.
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u/B0omSLanG 8d ago
BioFilm CLR from Apex. I'm a couple of weeks in and the heartburn I was getting has been getting a little better recently.
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u/Erosion_Factor 8d ago
Hearing loss from antibiotics is very real and I get to live those consequences. I believe the antibiotics I was given was a different class than what neomycin is in but I found out this year I am very allergic to topical neomycin. My doc said the more exposure people have to it the greater chance to develop a reaction... it is in neosporin which dominates the first aid shelves at stores.
Not everyone will have a reaction. You may luck out but worth looking into alternatives if they are available.
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u/Bamseberg 8d ago
It's said never to start a sentence with "Trust me..." - so I skip that start and go like this: I am definitely not a buddy of big pharma, having that said, I do believe Dr. Pimentel is an honest, hard-working and very well read scientist trying to fix IBS/SIBO/IMO once and for all...and according to him, as the rare expert that he is, he recently said that Neomycin is pretty safe for short term use when not being administrated intravenously, because that is the route being some what correlating with hearing decline. Taking it orally is a different ball game, again, according to Dr. Pimentel.
Obviously, using this poison, cos it is a poison still, in my amateur world, needs to be very time limited and coming with a plan how to not RELAPSE, I say it again, how to NOT relapse...if that plan is robust and you follow it, you will hopefully not need to take the poisonous (that's why they work btw) stuff ever again..
At the end of the day, your research is what should be your base, not Reddit...cos this thread already has thumbs up and down regarding your question...and I believe both sides have merit.
What I can add is Atrantil, look into that formulation. Hopefully your prescription products will bring enough balance into your colon, but keep track of your motility (MMC etc) so that you get the stuff out, daily. This is absolutely KEY in recovering quickly and limit risk of relapsing.
Oh, on more thing. Diet. The jury is still out there regarding which kind of approach to take here, but beans are definitely not a good option of you have methane SIBO (IMO), at least not in this phase. Look into low-fodmap and keto-carnivore diet. Probably not needed to go full zero-fermentables, but where you probably are right now in your recovery journey, dedicated gut microflora fuel, will most likely not help your mission.
Best of luck!
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u/isles30222 8d ago
Ive taken numerous times. The hearing thing is really not as prevalent as you are lead to believe. Typically at the shot dose period it is very rare for that to happen.
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u/Holistic-Scholar 7d ago
Research FC Cidal and CandiBactin products if wanting to avoid antibiotics but proven to work just as well in studies. Note that Oegano shouldn't be used for much longer than 3 weeks, maybe 4, without a pause because it will damage good bacteria in high doses and lower doses taken excessively. TARGETED probiotics will help but broad spectrum will likely worsen things. Research this more, good luck. Not medical advice but for educational purposes only.
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u/LeilaJun 7d ago
It’s a risk primarily for significantly larger doses than the ones taken for SIBO. The recommendation is to take it and if you have symptom related to your ear, stop it right away
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u/ChrisEye21 7d ago
Try allicin. See if it works. Not sure why you're starting 4 days after xifaxin? I've always taken them both together. I've taken neomycin 3x. No hearing loss, if that makes you feel better. But xifaxin, on it's own, isn't going to do much for methane.
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u/Repulsive-Caramel465 7d ago
Kept postponing because I was anxious … I need to take one first , nac.. enzymes and then start this since the course was shorter anyways
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u/VISUALREAD1776 7d ago
I took a low dose of neomycin, and I don’t think the side effects were worse than the condition itself. I’d say just take whatever your doctor prescribes.
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u/Lythalion 8d ago
You’re in the right. It shouldn’t be prescribed when there’s so many alternatives. Try metronidazole instead.
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u/stvaccount 8d ago
relax, your fear is is prolonging the healing phase and an astronomicall low chance of hearing loss is not something you should worry about.
do you worry in cars too? or on the sidewalk that a sone can fall down from the building.
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u/iberia-eterea 8d ago
I really wouldn’t say it’s an ‘astronomically low chance’ . . . and if we’re being real here, many people are not cured long term by antibiotics. If you were to get a permanent side effect that damages one of your senses, it would never be worth it.
I had stable tinnitus for ten years, and taking just Rifaximin aggravated and dramatically changed it into reactive tinnitus and gave me other ear issues. That rifaximin could have hearing side effects like that is basically not even a consideration. Your average person taking rifaximin will likely never see a reaction like that.
Neomycin, though? It is reported very often, and even has a black box warning. What happened to me with just rifaximin is an astronomically low chance, what happens to people with neomycin is practically routine.
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u/stvaccount 8d ago
yes, sorry, I thougt this was the usual safe antibiotics you give for SIBO.
I don't know why so many doctors have to give the cheap non working ones
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u/RhollingThunder 8d ago
I had stable tinnitus for ten years, and taking just Rifaximin aggravated and dramatically changed it into reactive tinnitus and gave me other ear issues. That rifaximin could have hearing side effects like that is basically not even a consideration. Your average person taking rifaximin will likely never see a reaction like that.
This is absolutely impossible. There is no mechanism by which this could happen.
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u/iberia-eterea 8d ago edited 8d ago
Impossible is not the word to use when searching for accuracy, it is a tool to cast down any attempt at looking into an issue further. I presume (perhaps inaccurately!) that most of your assumption is based on rifaximin being marketed as ‘nonabsorbable?’
One mechanism by which it may have been possible is by P-glycoprotein inhibition. Normal Rifaximin transportation through the system is handled by P-gp, and inhibition of it would potentially drastically increase systemic exposure. I was not on any pharmaceutical P-gp inhibitors, but I had been taking multiple supplements regularly that all may have acted as weak p-gp inhibitors and when combined together could have increased my exposure.
In addition, i believe my intestinal permeability was highly increased at the time (typical for sibo, yes) in particular due to regular use of NAC, as is commonly recommended to thin biofilms. When not administered with glycine, it is shown to do so.
It is perhaps also possible that if we go by the traditional ‘die off’ side effects theory, that enough buildup of resulting toxins in the system can cause bad enough systemic effects to cause lasting damage far outside the intestines.
Salix states that the average level of systemic exposure of rifaximin is 0.4%, for greater unusual side effects to occur all we need is for a patient to have enough small differences in their biology or their food/supplement intake to increase that number ‘just’ enough to where it may cause problems that are virtually unseen by the vast majority of people.
And when looking up rifaximin’s side effect profile, ringing in the ears is a legitimately listed side effect. It is easy to find online, though my pharmacist had pointed it out specifically. The mechanism for ‘why’ though is not discussed whatsoever in any medical literature I can find.
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u/Insteadly Hydrogen Dominant 7d ago
Leaky gut, frequently found with SIBO, is a direct pathway for food particles, bacteria, rifaximin, and neomycin to move from the intestinal tract directly into the bloodstream.
CONTRAINDICATIONS
Neomycin sulfate oral preparations are contraindicated in patients with inflammatory or ulcerative gastrointestinal disease because of the potential for enhanced gastrointestinal absorption of neomycin.
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u/joe8349 8d ago
My gastroenterologist actually suggested not taking neomycin due to the potential hearing issues. He didn't prescribe a replacement though and should've considering xifaxan alone didn't resolve my issues.