Dosing rifaximin 3 times a day is rarely ever used. If there are problems with the rate of recovery, I would recommend adding VNS before considering an unusual dosing regimen of rifaximin.
Typically I only start rifaximin if either inulin has proven ineffective or the child is in the teens years or older. If inulin never has in a child, going back to inulin or adding to rifaximin can sometimes help. If there is no apparent benefit of adding inulin after rifaximin, I stop the inulin.
Parents can continue to use inulin for as long as it is effective and produces ongoing neurological recovery. If recovery stalls (see Plateau) and no underlying medical issues are interfering with recovery, I recommend that parents move on to monthly Rifaximin.
Only increase to rifaximin if inulin fails to produce any neurological improvement (inulin failure) or when the pace of neurological recovery for all aspects comes to a halt (plateau).
Over time, from treating neurotypical adult patients, I have learned that their intestinal motility will improve. The relapses of bacterial overgrowth become less and less frequent, as will the need for rifaximin. This seems to hold for children as well.
Daily, continuous rifaximin has been safely used for almost thirty years in patients with advanced liver cirrhosis who develop hepatic encephalopathy. Patients with hepatic encephalopathy are placed on twice-daily rifaximin continuously to prevent dangerous ammonia production. Studies indicate the continuous use of rifaximin does not lower the bacterial biodiversity within the gut microbiome.
Rifaximin is an unusual medication as little to none of the medication is absorbed into the bloodstream. Because of this, there are almost no drug-to-drug interactions. Always tell your child’s doctor’s that they are taking rifaximin and if you are ever in doubt I suggest asking your child’s managing physician if The Nemechek Protocol is safe for your child.
Yes. Macrogol is the same as MiraLax.
Rifaximin is most commonly dosed twice daily. If you miss a dose, do not give a double dose at the next dosing interval; give a single dose and try to understand what led to missing the doses so you might miss fewer doses in the future.
Fluctuations in behavior between each round of rifaximin is a sign that bacterial overgrowth is successfully suppressed by rifaximin but is quickly relapsing after each round of medication is complete. Rapid relapsing will prevent substantial reduction of inflammation as well as recovery. I recommend my patients shift to continuous rifaximin at this point.