What should I do if the Plateau occurs?

A Plateau is when bacterial overgrowth recurs either because the inulin is no longer effective or because the dose or schedule of dosing for rifaximin is no longer effective.nnIf I suspect my patient is experiencing inulin failure and has hit the plateau, I believe the best treatment course at this point is to discontinue inulin and treat the child with monthly courses of rifaximin. Inulin is not restarted after treatment with rifaximin since its beneficial effects have proven inadequate to control overgrowth.nnIf the plateau occurs while on monthly rifaximin, I then increase the dosing schedule to continuous, twice-daily rifaximin.