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SIBO: Rosacea Subtype 2 and 3 caused by Demodex and underlying SIBO treatment


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Recent medical research studies have shown that at least 50-60% of people with Rosacea Subtype 2 also have tested positive for Small Intestine Bacterial Overgrowth (SIBO) caused by bacteria emitting Hyrdrogen or Methane gas.  Treatment with the right antibiotic to target the bacteria causing the SIBO resulted in clearance for the majority of the studies rosacea patients who tested positive for SIBO.  SIBO can be caused by a variety of different bacteria.  Different antibiotics work depending on the bacteria causing the SIBO.  Medical study paper using Rifaximin can be found here:


Study Limitations: 

1.  The study used the older 2 gas SIBO breath test which tested for Hydrogen or Methane gas only.   The third type of SIBO gas, Hydrogen Sulfide, was not included in the older 2 gas SIBO test.  In 2020, Researchers at Cedar Sinai came up with a new test for Hydrogen Sulfide SIBO.  One company offering a new Hydrogen Sulfide test for SIBO is here:


2.  Small Intestinal Fungal Overgrowth (SIFO) has the same symptoms as SIBO.   Tests for SIFO were not conducted.   Since the root cause is a fungal overgrowth, an oral anti-fungal drug would be necessary to eliminate the fungus.  An antibiotic would not work for SIFO.

3.  Only one antibiotic was used to treat all patients in the above study.   The very expensive antibiotic Rifaximin was used for treatment regardless of the bacteria causing the SIBO.   Rifaximin is excellent for at least 3 types of bacteria including non-bloody Traveler's diarrhea causing E. Coli, Enterococcus,  and Staphylococcus aureus.  Rifaximin while considered a broad spectrum antibiotic is less effective against other types of bacteria like Klebsiella and Enterobacter.   Other antibiotics like the very inexpensive Oral Metronidazole are highly effective against Bacterioides and Eggerthella Lenta which are also known to cause SIBO.

An earlier medical study report showed that an inexpensive, combined 2 drug, 2 week treatment with Oral Ivermectin + Oral Metronidazole was highly effective at clearing or greatly reducing demodex skin mites for patients with various rosacea symptoms who also tested positive for demodex skin mites.  This 2 drug treatment was compared to treatment with Oral Ivermectin only and was far more effective.  At the time of the study, the reason adding Oral Metronidazole to the Oral Ivermectin treatment was unknown.  Now it is clear that the Oral metronidazole was treating an underlying SIBO condition.  

Medical study paper from the May 2013 issue of The International Journal of Infectious Diseases:


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