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Medical Management of SIBO

Got to deal with small intestine bacterial overgrowth? Worry not! We are going to discuss all the available medical management options available to tackle this disorder. Antibiotics, which decrease the overgrowth of bacteria, in addition to vitamin, magnesium, and calcium supplements, may be used in the treatment of small intestine bacterial overgrowth (SIBO). The elemental diet and the low-FODMAP diet are two examples of specific diets that can be employed to assist people in avoiding items that cause symptoms.

Antibiotic Therapy

Currently, employing antibiotics to lessen the proliferation of bacteria in the small intestine is the most common for managing SIBO [1]. These drugs may help reduce the risk of small intestine lining irritation, which might result in malabsorption.

SIBO can be divided into two distinct groups:

  • Methane-dominant SIBO which results in constipation
  • Hydrogen-dominant SIBO which results in diarrhea.

Both kinds of conditions are treated with antibiotics, however methane-dominant SIBO may also call for fiber supplementation. Unfortunately, there are no definitive therapy recommendations for SIBO, and more investigation into the application of antibiotics for SIBO remains essential. SIBO is treated with a variety of antibiotics, although it is still unclear which type and how much of each antibiotic is beneficial for a given patient.

You might have come across these commonly prescribed antibiotics [2]:

  • Metronidazole 
  • Amoxicillin-clavulanate
  • Neomycin
  • Norfloxacin
  • Tetracycline
  • Ciprofloxacin
  • Rifaximin (Xifaxan)

Since the majority of patients appear to respond favorably to it, rifaximin is currently the main antibiotic employed for the treatment of SIBO. It improves symptoms by eliminating different bacterial strains [3]. It doesn’t get absorbed in the circulatory system when inside the body. As a result, there are fewer side effects and the medication is better able to interact with the microorganisms in the small intestine directly.

It also has little effect on the microorganisms in the large intestine, which is another advantage. This reduces the possibility of infections with yeast and adverse reactions in the gastrointestinal tract, which are frequent with other antibiotics. 

Future Developments

Every day, researchers are doing their best to find more suitable and reliable options to tackle this disorder. Additional treatments for SIBO are probably going to develop as more study is done on the condition. The creation of cutting-edge technology that will accurately determine the quantity as well as the variety of microbes that inhabit an individual’s small intestine is a particularly fascinating area of research [4]. Other potential approaches are being investigated as potential safe, efficient SIBO therapies in the interim.

Prokinetic Drugs

Gastrointestinal issues and reflux symptoms are treated with prokinetic drugs. They might also aid SIBO. According to research, individuals suffering from SIBO may benefit from these drugs the most. The ability of the small intestine’s inherent “cleansing wave” to remove bacteria may be strengthened by prokinetic drugs, which may make them advantageous.[5]

Herbal Formulations

According to one reported research, the herbal combination for addressing SIBO is not less than equally effective as Xifaxan. Additionally, herbal treatments claim to help those who are resistant to antibiotics while avoiding their adverse effects. They might also stop SIBO from recurring.[6]


Probiotic supplements have been demonstrated to have a favorable impact on bacterial composition, enhance the well-being of the intestinal wall, and lower inflammation, thus they may, in theoretical terms, be effective for managing SIBO [7]. The usefulness of probiotics in treating SIBO, however, has not been the subject of extensive investigation.

To put it simply, treating SIBO entails using antibiotics like rifaximin to drive those troublesome bacteria out of your small intestine. Prokinetic medications, herbal treatments, and probiotics are also taking part in the matter. 

Disclaimer: As always, this is not medical advice, just information regarding SIBO, so check with your medical professional to review your symptoms as well as medical options that may help address your condition. Before starting any of these things mentioned above, it is best to receive an individualized approach to see what may best work with you by a medical professional. 


[1] “Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy.” (accessed Jul. 10, 2023).

[2] S. C. Shah, L. W. Day, M. Somsouk, and J. L. Sewell, “Meta-analysis: antibiotic therapy for small intestinal bacterial overgrowth,” Aliment. Pharmacol. Ther., vol. 38, no. 8, pp. 925–934, 2013, doi: 10.1111/apt.12479.

[3] J. A. Barkin, T. Keihanian, J. S. Barkin, C. M. Antequera, and B. Moshiree, “Preferential usage of rifaximin for the treatment of hydrogen-positive small intestinal bacterial overgrowth,” Rev. Gastroenterol. Perú, vol. 39, no. 2, pp. 111–115, Apr. 2019, Accessed: Jul. 10, 2023. [Online]. Available:

[4] M. Ruscio, “Is SIBO A Real Condition?”.

[5] “Risk of small intestinal bacterial overgrowth in patients receiving proton pump inhibitors versus proton pump inhibitors plus prokinetics – Revaiah – 2018 – JGH Open – Wiley Online Library.” (accessed Jul. 10, 2023).

[6] “Herbal Therapy is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth – Victor Chedid, Sameer Dhalla, John O. Clarke, Bani Chander Roland, Kerry B. Dunbar, Joyce Koh, Edmundo Justino, Eric Tomakin, Rn, Gerard E. Mullin, 2014.” (accessed Jul. 10, 2023).

[7] “Effect of a Preparation of Four Probiotics on Symptoms of Patients with Irritable Bowel Syndrome: Association with Intestinal Bacterial Overgrowth | SpringerLink.” (accessed Jul. 10, 2023).

Dr. Tyrrell Jenkins

Hi, I'm Dr. TJ

Health Coach + Experienced Physician

Dr. Tyrrell Jenkins, affectionately known as Dr. TJ, has practiced medicine in 4 areas, including outpatient primary care, urgent care, hospital medicine, and the intensive care unit, which are all unique and have given him a significant breath of clinical experience that many physicians do not possess. This has allowed him to assess and manage the continuum of diseases.


1:1 Private Coaching

Private 1:1 coaching program is specifically for those who have struggled and become frustrated with their thyroid dysfunction, irritable bowel syndrome (IBS), or small intestinal bacterial overgrowth (SIBO) condition. This private coaching is for those who have tried restrictive diets and feel that they are going in circles with no improvement. This is for those who are looking to fast track their progress with a personalized approach.

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