Rifaximin for a mother of a 3 month old?

[Betsy]

I talked to a mom yesterday who has Small Intestine Bacterial Overgrowth. She's very ill. Her disease went into remission with her pregnancy, but is back in full force now that she is nursing a 3 month old. Her naturopath has said the only known treatment is Rifaximin (trade name Xifaxan) 600mg BID x 7 days
Erythromycin 50mg HS x 90 days, started upon completion of Rifaximin.

The naturopath insists, based on Hale saying Rifaximin is an L3, that she must pump and dump for the duration of the Rifaximin treatment. However, she is doing 10 days pf Rifaximin.
She is now committed to pumping every day for the next 30 days to stockpile the 300 ounces she would need to feed her baby during the 10 days of the Rifaximin.
Can any of you help me provide this mom with some information? it seems to me based on Hale's saying it is unlikely enough would enter the maternal plasma compartment to produce clinically relevant levels in milk, it's probably ok. Thoughts?

[Betsy]

to add about this mom...

doctor says she now has leaky gut, which means the drug would enter her bloodstream and potentially more into her milk.

[admin]

Betsy:

Rifaximin is virtually unabsorbed in adults( < 0.04%), and probably similarly in infants. I'm not sure that it is necessary for this mom to discontinue breastfeeding while taking an antibiotic that is virtually unabsorbed orally in adults, or a 3 month-old infant.

What little would be absorbed in the mother's plasma, would be poorly transferred to her milk, and then virtually unabsorbed orally in the infant. I don't see a big problem with the use of this antibiotic in this situation.

Tom Hale Ph.D.

[Betsy]

just to confirm...

Dr. Hale, the mama hates to bother you but would love to clarify: "I need to take Rifaximin and the deciding factor is my leaky gut. That is the question I need answered, because I know the medication isn't systemic. It doesn't leave the gut except a tiny percent; however, is their a risk being that the chronic SIBO has compromised my intestines causing leaky gut. What about then? That is why my doctor is not prescribing it to me.
She is worried about it transferring through my ravaged gut (remember I've had it 3yrs and just before that I was treated for giardia that I had for 6mos). You have been UBER helpful. Is their anyway you can get clarification on that point? Thank you tons!
Treatment
Specific Carbohydrate Diet (SCD) ongoing
Klaire Ther-Biotic (25 billion multi-strain) BID ongoing
Rifaximin (trade name Xifaxan) 600mg BID x 7 days
Erythromycin 50mg HS x 90 days, started upon completion of Rifaximin"

thanks so much,
Betsy Hoffmeister, MPA, IBCLC

[cpride]

Dear Betsy,

You may want to have the physician call us. We can explain the information that Dr. Hale answered on your previous forum question. The InfantRisk Center phone number is 806-352-2519. We are open Monday through Friday, 8 to 5, CDT.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center