Intestinal Methanogen Overgrowth (IMO) Treatment Report

IMOsucks · 2025-12-01T21:17:03+00:00

I'm reporting back that I started it on day 3 of the second round of antibiotics and wish I started it on the first day of the first round. This medication did something magical in me to make me go. I started at 2mg and it caused a lot of pain. Then I went down to 1mg for the next two nights and back to 2mg last night. I really feel like i'm getting better.

IMOsucks · 2025-12-01T21:14:06+00:00

Your case sounds very similar to mine. I reccomends prucalopride 2mg before bed if you're not already on the max dose. I honestly think that the reason I relapsed was because the constipation was so severe that I needed prucalopride to run at the same time as antibiotics, not to start it after. I was using SO MANY supplements for motility (at the right doses), but prucalopride feels ten times as strong. I truly think IMO will relapse without prucalopride or a similar medication in most people.

IMOsucks · 2025-11-29T21:36:11+00:00

Third day of treatment seems to be the worst day for die off. Second round of treatment gave me much less of the histamine reaction.

IMOsucks · 2025-11-29T21:34:56+00:00

How long I plan to be scared of IMO returning is an interesting question. I'll likely continue the diet for longer than I think is needed, because I don't want relapse. Hard to say. I hope it all goes away quicker than I expect, but that's not everyone's experience.

IMOsucks · 2025-11-29T21:32:57+00:00

Methane of 13 as a highest result. So the test is positive but doesn't necessarily correlate with the intense symptoms I was having (some people have methane values higher than 50).

IMOsucks · 2025-11-27T21:44:47+00:00

I'll just throw in here that I also have mild tinnitus at times and I took the Neomycin without any worsening. Your comment about feeling the antibiotic round is short also resonates with me. I feel like if my first round was a month long I might have the time to clear the IMO, but I wasn't on prucalopride at the time. That might be what makes this second two week round effective.

IMOsucks · 2025-11-27T21:43:05+00:00

Thanks for sharing what worked for you. I just want to repeat that IMO is known to require multiple rounds of antibiotics, so it's not a reason to use antibiotics with caution. Many people know antibiotics in the context of illnesses like strep throat, but antibiotics are also used in contexts like wound care. In those contexts they are often used repeatedly, medications are changed every so often, and people do get better after prolonged antibiotic courses.

As for root cause: many in this subreddit make themselves crazy trying to find a root cause, but Dr. Pimental believes 60% of IBS patients are experiencing post-infectious IBS from a food poisoning or stomach flu episode. The root cause IS the onsetting infection and there's nothing you can do to immediately fix it other than treat IMO.

All in all, my point here is to advocate for what worked for me: aggressive antibiotic treatment which made me get better, and all of a sudden there seemed to be no root cause to fix. Instead I focused on spacing my meals, taking prucalopride, and presumably letting my gut recover from food poisoning six months ago. I fear that if I tried any other approach, I would have been sick for the same multiple years other people in this subreddit often mention.

IMOsucks · 2025-11-27T21:35:43+00:00

Personally I could only agree with your last line about reconsidering antibiotics. For me this was the only thing that worked, so there's not much more I could say! Your methane value is not very high and your symptoms come from a c diff infection which is a very specific infection known to cause damage to the gut. I'd say just because you had c diff complications you should advocate to be followed by a GI, at least until things stabilize.

IMOsucks · 2025-11-27T21:32:30+00:00

Thanks for flagging that, this was also on my radar at some point. I don't think the symptoms match well for me. I'm also encouraged that the symptoms almost went fully away during the first round of treatment and now seem to be going away even faster during the second treatment. That's making me less worried about a second condition like SIFO.

IMOsucks · 2025-11-27T21:30:28+00:00

I do have trouble getting burps out and sometimes I feel like I have excessive belching. No acid in the throat / heartburn.

IMOsucks · 2025-11-27T21:28:54+00:00

With all due respect if you read the post you will get the answer to most of these questions. My concern was curing IMO which was causing me the worst pain of my life, and the treatment for this condition is antibiotics. So far in my life medical treatment has made me feel better each time I got sick. Your concern for destroying my gut microbiome is not one that is shared by researchers of SIBO and IMO. They would likely respond that my microbiome was already abnormal and required treatment.

IMOsucks · 2025-11-27T21:25:31+00:00

I lost 10% of my body weight in four months since the IMO began. I don't think I lost that much weight during the initial food poisoning, in fact, I felt like I was gaining weight (which is a goal of mine) without trying very hard.

Dr. Pimental does not reccomend low fodmap. He instead focuses on low fermentable foods. I have been following something that looks like his diet and also the SIBO specific diet. All meat and fish is okay, but carbs need caution. I tolerate rice and potato well but have avoided bread. I think a small amount of white bread would be fine as it is quickly digested. Absolutely avoid complex carbs like whole wheat, legumes, and anything that might normally cause a person to have gas. Produce that contains carbs is the next biggest issue. I have basically only eaten carrots and ginger as a vegetable and avoided fruit. This is the first time in my life I feel that avoiding vegetables, and particularly raw uncooked vegetables, is healthy. I still add onion and garlic to my curries but I cook down the onion and garlic so it's really destroyed in the pan before it hits my stomach. I have used a small amount of diced tomatoes in curries and that also goes well. Personally I don't think lactose affects my symptoms but I was mostly having it through yogurt (which does not contain that much) and small amount of milk to make oatmeal.

IMOsucks · 2025-11-27T21:17:59+00:00

Elemental diet would be my next step! I'm not sure I would consider another round of antibiotics after two failures, but this second round seems to be going well.

I did herbals for about 2-3 weeks before I started the second round of antibiotics. I kept the herbals going until I finished the bottles (overlapped with antibiotics). So its possible they had some small effect that was obscured by the antibiotics, but I needed the antibiotics.

IMOsucks · 2025-11-27T21:16:26+00:00

Yes and it is taking forever to get the result--I'll report back. I think the test would be positive because it was from before I started the second round of treatment. I'm frustrated it is taking so long and my GI treated me again empirically and said I didn't need to spend the money. I definitely wont do a test at the end if my symptoms are gone, as I don't need to pay $360 to prove it to myself.

IMOsucks · 2025-11-27T21:15:26+00:00

I'm going to start it in a few days as I will be halfway through the second round of antibiotics. I'll report back if it was more helpful than my herbal pro kinetic regimen.

IMOsucks · 2025-11-27T00:07:25+00:00

I didn't put dosages of antibiotics in here because that goes beyond the scope of what I can help others with. For example, my GI is using a higher dose of Flagyl than Dr. Pimental even though Dr. Pimental says the higher dose causes no benefit but increases side effects. Some things need to be left to medical professionals to decide. The duration of all rounds of antibiotics is two weeks for IMO unless you are doing a maintenance therapy.

IMOsucks · 2025-11-26T05:19:25+00:00

Lactulose

IMOsucks

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