My child just finished his 2nd monthly round of rifaximin. I am finding during the 10 day course he is more aggressive but the behaviors seem to calm after the 10 day course is complete. Is this common? Should I be doing something differently?

The aggression you are seeing is part of the awakening, and the calming effect is from the bacteria relapsing. When I see this see-sawing behavior, I recommend that my patients increase to continuous rifaximin. Although the negative behaviors will increase, they will begin to decline within a month or two as a brain starts repairing itself.