From the Guidelines
The treatment for Small Intestinal Bacterial Overgrowth (SIBO) should involve antibiotic therapy, with poorly absorbable antibiotics such as rifaximin being preferred. The most recent and highest quality study, 1, suggests that sequential antibiotic therapy is very effective in treating intestinal bacterial overgrowth and reducing malabsorption. This approach has also been shown to improve nutritional status and sometimes bloating. Some key points to consider when treating SIBO include:
- The use of alternating cycles with metronidazole and tetracycline may be necessary to limit resistance 1
- In clinical practice, the most commonly used antibiotics are metronidazole, amoxicillin-clavulanate, doxycycline, and norfloxacine 1
- Bacterial overgrowth may lead to life-threatening bacterial translocation, making prompt and effective treatment crucial 1 It is essential to prioritize the treatment approach that minimizes morbidity, mortality, and improves quality of life, which in this case, involves the use of antibiotic therapy as the primary treatment for SIBO.
From the Research
Treatment Options for SIBO
- Rifaximin is a commonly prescribed antibiotic for the treatment of SIBO, with response rates ranging from 47.4% to 80% depending on the type of SIBO [(2,3,4,5,6)].
- The typical dosage of rifaximin for SIBO treatment is 550 mg three times daily for 14 days [(2,3)].
- Rifaximin has been shown to be effective in eradicating SIBO in up to 84% of patients with IBS, with results sustained up to 10 weeks post-treatment 4.
- Compared to metronidazole, rifaximin has been found to have a higher SIBO decontamination rate and better tolerability 5.
Efficacy of Rifaximin
- Rifaximin has been found to improve global symptoms in 33-92% of patients with IBS and SIBO 4.
- The antibiotic has been shown to cause a significant reduction in hydrogen and methane production in breath tests, indicating its effectiveness in treating SIBO [(2,3,6)].
- Rifaximin has also been found to be safe and well-tolerated, with a lower number of adverse events compared to other antibiotics [(4,5,6)].