Started 10-day Metronidazole course. Feedback is appreciated

[smallman007]

Hello everyone,

Today I am starting a 10-day course of Metronidazole after having had the GI effects test done. I convinced my GI doctor to prescribe me the antibiotic after showing her that the strains I had in overabundance in my stool (Prevotella spp, desulfovibrio piger, among others) have been consistently shown to be a culprit for chronic halitosis. I initially requested her to prescribe me 3 different antibiotics (triple therapy) as I have read it is usually the go-to therapy for SIBO, dysbiosis, and other Gi disorders, but she wasn't completely convinced of my arguments and told me Rifaxin would be the best for me. I went to the pharmacy and was told this was ~$800 for a 10-day course, so I immediately called my GI doctor and told her that that would not be possible for me. She ended up prescribing Metronidazole as she thought the triple therapy wasn't suitable for this case.

In addition to the antibiotic, I will be limiting my carbohydrate and alcohol intake, and will take a variety of probiotics, prebiotics, digestive enzymes, betaine HCl, Goldenseal, arabinogalactan, and astralagus, among others.

My understanding is very limited in this condition so any constructive remarks will be greatly appreciated. I will take questions as well.

If the therapy eradicates this condition permanently, I will be glad to write a detailed process of everything that I went through. As for now, sorry for the lack of details and writing style.

[Corpsebreath]

Hi! What study or information did you show your doctor about those strains causing bad breath? Could you post a link to that study please?
Also, what other symptoms do you have than bad breath?

[smallman007]

Hi! What study or information did you show your doctor about those strains causing bad breath? Could you post a link to that study please?
Also, what other symptoms do you have than bad breath?

I'll be happy to write a comprehensive piece including all the information that I have gathered once I finish the treatment course. Sorry, but I would just rather write and present once rather than multiple times little by little. I feel the information will be more organized and will therefore help me and others more. Just 9 more days (June 9th.)

What have you tried to address this condition if I may ask?

[Corpsebreath]

Well, if you're asking people for constructive remarks then you're gonna have to supply some more info, like what your other symptoms are, reflux, pnd, etc. Do you have extra- or intra oral halitosis? Is it your tongue that smells? How far does it reach?

What have i tried to address this condition? Like a million things, including at least ten courses of anti biotics. Probably have been on metronidazole alone five times.

[smallman007]

Well, if you're asking people for constructive remarks then you're gonna have to supply some more info, like what your other symptoms are, reflux, pnd, etc. Do you have extra- or intra oral halitosis? Is it your tongue that smells? How far does it reach?

What have i tried to address this condition? Like a million things, including at least ten courses of antibiotics. Probably have been on metronidazole alone five times.

I suffer mildly from reflux, not to the point (in my opinion,) where it is a cause of concern. I say this assuming that everyone experiences reflux from time to time right? Now the problem however is that I may indeed suffer from GERD but it is asymptomatic as my GI doctor considered. Interestingly reflux intensity has increased slightly from when I started Metronidazole.

I definitely suffered from pnd for a long time until approximately 8 months ago. I thought pnd was the main source of my halitosis until I effectively eradicated it with oil of oregano and some other chemicals that I don't remember exactly right now. I was incredibly satisfied that I didn't have to clear my throat constantly, and that I could go to bed without feeling mucus in the back of the mouth. Needless to say, pnd was not the cause but possibly just a comorbidity or another symptom of the principal cause.

Foul odor is almost exclusively intra-orally, with a small but noticeable smell coming off my nostrils when I exhale very strongly. Not too concerned with that smell as it is almost nonexistent. I believe the overwhelming majority of the odor is from my tongue, which is covered in a white layer, and which this in turn changes in consistency depending on usage of mouthwash, orabrush, diet, etc.

Something interesting that made me think that halitosis had a systemic cause, was that I have eaten a variety of cheeses (blue, roquefort, etc,) with different bacterial contents (due to different production methods) and have experienced almost instantaneous, complete, relief in odor. That was incredibly surprising to me at first because I experience quite the opposite with milk and lactose products. Following that idea, together with the ideas in the literature that I had read which talked about probiotics and prebiotics, I researched scientific articles instead of random articles on the internet. These two are very good papers in my opinion summarizing large amounts of evidence: http://www.kumj.com.np/issue/30/269-275.pdf, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633265/. Note particularly "Microflora associated with halitosis," and Table 1, 3, and 4, respectively. I just wish I had made the shift from reading unfounded, and sometimes even factually incorrect articles on the internet into scientific articles, since the former state almost exclusively that the odor is caused due to lack of hygiene.

Something else that is interesting but do not know how it is related to all this is that whenever I drink a lot of alcohol on a friday or saturday night for example, the following day I do not have bad breath. I suffer from a hangover, with dry mouth included, but no foul odor! Is the alcohol, an antimicrobial, killing the VSC producing bacteria (in addition to mutualistic and commensalist microbes)?

Finally it is also worth noting that I had at least 2 surgeries in my childhood that required the use of antibiotics. Broad spectrum antibiotics might have allowed VSC bacteria to outcompete randomly other bacteria, overpopulating my GI. I have suffered halitosis for as long as I can remember, with no exact beginning.

Now my questions are, were the 10 courses of antibiotics for the treatment of halitosis only, or for other conditions too? What were the different antibiotics used? For how long? How many mg per day? Did you change your diet within the courses and before and after them? Did you take supplements (probiotics, etc.) What do your doctor(s) say about this? Did you experience relief? What other symptoms do you present?
(I am amazed you have been through so many rounds of antibiotics. My doctor was incredibly hesitant in prescribing me Metro. due to the side effects and the large scale consequences that overuse of antibiotics can cause in a population.)

[halitosisux]

Hi smallman, good luck with what you're trying. There are a number of threads on here discussing metronidazole which, if you haven't already seen them, you may find interesting.

Are you or have you ever been h.pylori positive?

People with chronic halitosis who get treated (with metronidazole) for h.pylori do sometimes find their chronic halitosis has been eradicated. It is not clear whether it's due to the eradication of the h.pylori or something else because this can happen even when the h.pylori hasn't been successfully eradicated. There have been studies to try to understand why, but they've been inconclusive. It's probably because of SIBO (due perhaps to the h.pylori), or simply changes to a more "favorable" (in BB terms) gut or oral flora, or the eradication of a chronic bacterial infection/situation elsewhere such as in the sinuses.

[smallman007]

[quote="halitosisux"]Hi smallman, good luck with what you're trying. There are a number of threads on here discussing metronidazole which, if you haven't already seen them, you may find interesting.

Are you or have you ever been h.pylori positive?

People with chronic halitosis who get treated (with metronidazole) for h.pylori do sometimes find their chronic halitosis has been eradicated. It is not clear whether it's due to the eradication of the h.pylori or something else because this can happen even when the h.pylori hasn't been successfully eradicated. There have been studies to try to understand why, but they've been inconclusive. It's probably because of SIBO (due perhaps to the h.pylori), or simply changes to a more "favorable" (in BB terms) gut or oral flora, or the eradication of a chronic bacterial infection/situation elsewhere such as in the sinuses.[/quote?]

H. Pylori negative. I was extremely sad when I got negative test results actually because it was going to be harder to get antibiotics prescribed, and because treatment for h. Pylori and associated halitosis seems to be easier to treat than halitosis by itself (Even if it is for the same causes!) I asked my gi doctor to prescribe me a proton pump inhibitor (w triple therapy) since that's what h. Pylori with halitosis patients get, but since I was h pylori negative I wasn't able to. hopefully she made the right decision, but I think doctors trained more than 10-15 years ago are not understanding fully that halitosis can be caused due to a bacterial imbalance in the gi. This notion is fairly recent I believe.

What have you tried? Are you BB free?

Thank you for your insight. You seem to be fairly knowledgeable on this.

[halitosisux]

I've been very lucky in eventually finding a dental cause to my BB, but not after having gone to the ends of the earth first, eliminating other potential causes. The biggest step I took was a tonsillectomy. They were producing masses of tonsil stones and yet the tonsillectomy hardly made any difference at all.

I also remember being crushed with disappointment after I rang my GP to find out the result of my helicobacter blood test to be told it was negative. I still managed to convince my doctor to try triple therapy, and even after that I managed to convince him to refer me for a stomach endoscopic examination and biopsy. All negative.

Over the course of decades I tried different antibiotics mostly aimed towards my sinuses, thinking I had an infection of some kind up there because of congestion and PND and rhinitis. I have a deviated septum, so maybe that's all it was. I still have lots of PND, but it's clear and doesn't smell bad. This PND originates in my nose, not my throat.

I never tried nasal irrigation because this has risks of making the problem worse if indeed there is an infection present in the sinuses. I had sinus xrays throughout my childhood to monitor the situation regarding my deviated septum until I was old enough to have surgery, but in the end my nose grew large enough to make surgery unnecessary. That's actually when I was first able to detect my own BB.

I never bothered with potions, except for acidophillus, which definitely seemed to help a bit. I never tried with any kind of specific diet or elimination of any specific foods. I have been tested for gluten intolerance - negative.

If I can remember anything else I'll report back. Feel free to ask any questions relating to what I've detailed, but I won't be able to reply until the evening (UK)

[Corpsebreath]

Well, if you're asking people for constructive remarks then you're gonna have to supply some more info, like what your other symptoms are, reflux, pnd, etc. Do you have extra- or intra oral halitosis? Is it your tongue that smells? How far does it reach?

What have i tried to address this condition? Like a million things, including at least ten courses of antibiotics. Probably have been on metronidazole alone five times.

I suffer mildly from reflux, not to the point (in my opinion,) where it is a cause of concern. I say this assuming that everyone experiences reflux from time to time right? Now the problem however is that I may indeed suffer from GERD but it is asymptomatic as my GI doctor considered. Interestingly reflux intensity has increased slightly from when I started Metronidazole.

I definitely suffered from pnd for a long time until approximately 8 months ago. I thought pnd was the main source of my halitosis until I effectively eradicated it with oil of oregano and some other chemicals that I don't remember exactly right now. I was incredibly satisfied that I didn't have to clear my throat constantly, and that I could go to bed without feeling mucus in the back of the mouth. Needless to say, pnd was not the cause but possibly just a comorbidity or another symptom of the principal cause.

Foul odor is almost exclusively intra-orally, with a small but noticeable smell coming off my nostrils when I exhale very strongly. Not too concerned with that smell as it is almost nonexistent. I believe the overwhelming majority of the odor is from my tongue, which is covered in a white layer, and which this in turn changes in consistency depending on usage of mouthwash, orabrush, diet, etc.

Something interesting that made me think that halitosis had a systemic cause, was that I have eaten a variety of cheeses (blue, roquefort, etc,) with different bacterial contents (due to different production methods) and have experienced almost instantaneous, complete, relief in odor. That was incredibly surprising to me at first because I experience quite the opposite with milk and lactose products. Following that idea, together with the ideas in the literature that I had read which talked about probiotics and prebiotics, I researched scientific articles instead of random articles on the internet. These two are very good papers in my opinion summarizing large amounts of evidence: http://www.kumj.com.np/issue/30/269-275.pdf, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633265/. Note particularly "Microflora associated with halitosis," and Table 1, 3, and 4, respectively. I just wish I had made the shift from reading unfounded, and sometimes even factually incorrect articles on the internet into scientific articles, since the former state almost exclusively that the odor is caused due to lack of hygiene.

Something else that is interesting but do not know how it is related to all this is that whenever I drink a lot of alcohol on a friday or saturday night for example, the following day I do not have bad breath. I suffer from a hangover, with dry mouth included, but no foul odor! Is the alcohol, an antimicrobial, killing the VSC producing bacteria (in addition to mutualistic and commensalist microbes)?

Finally it is also worth noting that I had at least 2 surgeries in my childhood that required the use of antibiotics. Broad spectrum antibiotics might have allowed VSC bacteria to outcompete randomly other bacteria, overpopulating my GI. I have suffered halitosis for as long as I can remember, with no exact beginning.

Now my questions are, were the 10 courses of antibiotics for the treatment of halitosis only, or for other conditions too? What were the different antibiotics used? For how long? How many mg per day? Did you change your diet within the courses and before and after them? Did you take supplements (probiotics, etc.) What do your doctor(s) say about this? Did you experience relief? What other symptoms do you present?
(I am amazed you have been through so many rounds of antibiotics. My doctor was incredibly hesitant in prescribing me Metro. due to the side effects and the large scale consequences that overuse of antibiotics can cause in a population.)

We seem to present with very similar conditions you and me. I have also had halitosis for as long as i can remember, originating from my tongue. Unfortunately my condition went from moderate to quite severe after coming down with some sort of illness three years ago. I was bedridden for ten days with fever and stomach cramps. They never found the exact cause, only that i had caught some sort of bug. I was put on a seven day course of ciprofloxacin which eventually cleared it out. But ever since then my breath has been so much worse. It now travels up to 2-3 meters on its worst, whereas before it traveled maybe 0,5 meters on its worst. I wonder if i now have multiple causes for halitosis or if simply the original cause worsened. I also now have this constant bitter/sour taste in my mouth which i didn't before.

Since then i have tried just about everything i can think of to rid myself of this. I rarely bother with doctors because it takes months just to get an appointment here. I just order everything online. I have mainly been focusing on trying to fix my gut flora, and also on trying to find a possibe local cause within the oral-, sinus region. The antibiotics i have tried so far are the triple therapy, and the ones used for treating SIBO including Rifaximin, and also the metronidazole, fluconazole combo. I usually combine them with various supplements and follow them up with heavy dosages of probiotics for a few weeks. The antibiotics always helps short term, but the halitosis always come back, usually about ten days after i've finished the course. It doesn't seem to make a difference the length of the course. The longest i've been on them was for about a month i believe. It was the triple therapy. Pretty sure i permanently screwed up my gut flora from that one. I don't remember the exact dosages that i have been using.

I also noticed the same thing you did about blue cheezes. I was surprised the first time. You look at that smelly, molding thing and you just know it can't be good for your breath. But it turns out you were wrong. I think it's because many types of yeast has anti biotical properties. Did you know that penicillin is derived from a fungi?

If you truly believe that fixing your gut flora is the answer for you, then i recommend reading up on fecal transplants. It's an emerging and very promising treatment, or cure for various gut related disorders. It has been shown to be way more efficient at for example eradicating C. diffile infections than anti biotics alone. It has also supposedly cured people from a number of different gut disorders such as IBS. In short, it's about replacing your own "sick" shit with someone elses "healthy" shit, and if successful you will get a more balanced and diverse gut flora. If you're interested then i recommend going to thepowerofpoop.com and check that out.

All the research i have read about the gut flora points to the more diverse it is, the healthier. The many different bacteria species are keeping eachother in check, so that people who have a lot of different species acutally have less bacteria overall. And to be fair, antibiotics could never increase the number of species in the long run, only reduce it.

Oh, and check out the adenoid thread if you haven't already.
viewtopic.php?t=6255

[smallman007]

I've been very lucky in eventually finding a dental cause to my BB, but not after having gone to the ends of the earth first, eliminating other potential causes. The biggest step I took was a tonsillectomy. They were producing masses of tonsil stones and yet the tonsillectomy hardly made any difference at all.

I also remember being crushed with disappointment after I rang my GP to find out the result of my helicobacter blood test to be told it was negative. I still managed to convince my doctor to try triple therapy, and even after that I managed to convince him to refer me for a stomach endoscopic examination and biopsy. All negative.

Over the course of decades I tried different antibiotics mostly aimed towards my sinuses, thinking I had an infection of some kind up there because of congestion and PND and rhinitis. I have a deviated septum, so maybe that's all it was. I still have lots of PND, but it's clear and doesn't smell bad. This PND originates in my nose, not my throat.

I never tried nasal irrigation because this has risks of making the problem worse if indeed there is an infection present in the sinuses. I had sinus xrays throughout my childhood to monitor the situation regarding my deviated septum until I was old enough to have surgery, but in the end my nose grew large enough to make surgery unnecessary. That's actually when I was first able to detect my own BB.

I never bothered with potions, except for acidophillus, which definitely seemed to help a bit. I never tried with any kind of specific diet or elimination of any specific foods. I have been tested for gluten intolerance - negative.

If I can remember anything else I'll report back. Feel free to ask any questions relating to what I've detailed, but I won't be able to reply until the evening (UK)

halitosisux what was your dental cause to your BB? Wisdom teeth? Periodontitis? Cavities?

[smallman007]

Well, if you're asking people for constructive remarks then you're gonna have to supply some more info, like what your other symptoms are, reflux, pnd, etc. Do you have extra- or intra oral halitosis? Is it your tongue that smells? How far does it reach?

What have i tried to address this condition? Like a million things, including at least ten courses of antibiotics. Probably have been on metronidazole alone five times.

Now my questions are, were the 10 courses of antibiotics for the treatment of halitosis only, or for other conditions too? What were the different antibiotics used? For how long? How many mg per day? Did you change your diet within the courses and before and after them? Did you take supplements (probiotics, etc.) What do your doctor(s) say about this? Did you experience relief? What other symptoms do you present?
(I am amazed you have been through so many rounds of antibiotics. My doctor was incredibly hesitant in prescribing me Metro. due to the side effects and the large scale consequences that overuse of antibiotics can cause in a population.)

We seem to present with very similar conditions you and me. I have also had halitosis for as long as i can remember, originating from my tongue. Unfortunately my condition went from moderate to quite severe after coming down with some sort of illness three years ago. I was bedridden for ten days with fever and stomach cramps. They never found the exact cause, only that i had caught some sort of bug. I was put on a seven day course of ciprofloxacin which eventually cleared it out. But ever since then my breath has been so much worse. It now travels up to 2-3 meters on its worst, whereas before it traveled maybe 0,5 meters on its worst. I wonder if i now have multiple causes for halitosis or if simply the original cause worsened. I also now have this constant bitter/sour taste in my mouth which i didn't before.

Since then i have tried just about everything i can think of to rid myself of this. I rarely bother with doctors because it takes months just to get an appointment here. I just order everything online. I have mainly been focusing on trying to fix my gut flora, and also on trying to find a possibe local cause within the oral-, sinus region. The antibiotics i have tried so far are the triple therapy, and the ones used for treating SIBO including Rifaximin, and also the metronidazole, fluconazole combo. I usually combine them with various supplements and follow them up with heavy dosages of probiotics for a few weeks. The antibiotics always helps short term, but the halitosis always come back, usually about ten days after i've finished the course. It doesn't seem to make a difference the length of the course. The longest i've been on them was for about a month i believe. It was the triple therapy. Pretty sure i permanently screwed up my gut flora from that one. I don't remember the exact dosages that i have been using.

I also noticed the same thing you did about blue cheezes. I was surprised the first time. You look at that smelly, molding thing and you just know it can't be good for your breath. But it turns out you were wrong. I think it's because many types of yeast has anti biotical properties. Did you know that penicillin is derived from a fungi?

If you truly believe that fixing your gut flora is the answer for you, then i recommend reading up on fecal transplants. It's an emerging and very promising treatment, or cure for various gut related disorders. It has been shown to be way more efficient at for example eradicating C. diffile infections than anti biotics alone. It has also supposedly cured people from a number of different gut disorders such as IBS. In short, it's about replacing your own "sick" shit with someone elses "healthy" shit, and if successful you will get a more balanced and diverse gut flora. If you're interested then i recommend going to thepowerofpoop.com and check that out.

All the research i have read about the gut flora points to the more diverse it is, the healthier. The many different bacteria species are keeping eachother in check, so that people who have a lot of different species actually have less bacteria overall. And to be fair, antibiotics could never increase the number of species in the long run, only reduce it.

Oh, and check out the adenoid thread if you haven't already.
viewtopic.php?t=6255

You seem to have moved your focus from your gut flora to your oral-, sinus region, since you have tried a variety of treatments to address your GI and have seen only temporary relief. I assume I will go the same path, only if a number of antibiotic treatments do not serve helpful. If one or two more antibiotic treatments are not successful in eradicating the condition I think I will have my tonsils checked and have a tonsillectomy (in addition to adenoids,) and then put up with the shit of someone else in fecal transplant therapies. They sound extremely interesting and I first heard about them when my Biochemistry professor referred to them in class, but I'm not psychologically ready haha. As for now I am trying to focus my attention to experimenting with my GI.

I believe your research is in accordance with mine. More flora, as in a greater diversity, is conducive to a healthier gut. However, I do not agree with your last statement. If the bacterial diversity of an individual is significantly reduced to only a few species, yet incredibly abundant covering the entirety of the surface area and not allowing other strains to be present, then antibiotics will eliminate this imbalance wiping all of them. It is then an obligation to the individual to try to repopulate with as many different strains as possible yet maintaining a balance in them with probiotics and prebiotics in my opinion. Furthermore, if the repopulation of bacteria is not balanced, the addition will yet still be better than before the antibiotic treatment because probiotics and prebiotics will not allow the proliferation of the specific strains of bacteria that are responsible for chronic halitosis. In a few words, I think VSC producing bacteria are only a few strains, so if eliminating these completely, and beneficial bacteria as well compromising diversity, then I still think it is reasonable to do so. This is if we assume that we give more importance to the eradication of halitosis than to the overall health of our gut.

[halitosisux]

Yes, 1 of my lower wisdom teeth. It wasn't just partially erupted, it was so far back in my mouth it was half grown and half buried in the wall of tissue right at the back. If you look in a mirror you'll know where I mean. The tooth wasn't decayed at all, but the gum underneath probably was having some bacterial intrusion.