- Antibiotics for SIBO
The main treatment is antibiotics. Rifaxamin is one of the best studied and is 70% effective. It is particularly effective if hydrogen-producing bacteria are present in the small bowel, but if there is methane production, a second antibiotic, often Metronidazole or Neomycin, is required. Antibiotics are usually prescribed for 2-4 weeks.
- Dietary management of SIBO
Several diets have been studied for the treatment of SIBO. Because we know that gut bacteria digest and ferment undigested sugars and carbohydrates, diets low in these carbohydrates have been suggested as a potential treatment for SIBO. Low fermentable diets such as the low FODMAP diet, or the low carbohydrate ‘keto’ diet have been suggested as possible treatments, however, there is currently no sound proof for this.
- Probiotics for SIBO
The role of probiotics in the treatment of SIBO is not currently clear. One recent study, which pooled together all the data from existing studies, suggested that probiotics may be effective in treating SIBO in some people, but long-term use did not appear to prevent the recurrence of SIBO. This area needs further study.
- Herbal remedies
Some natural substances such as thyme, sage, oregano, wormwood, berberine, grapefruit seed, garlic, ginger, rhubarb, and liquorice are commercially available in combination as capsules. Many of these substances have been shown to have antibacterial properties and are commonly used in Chinese medical practice. Many people with IBS and SIBO take complementary and alternative therapies and some people absolutely swear by them, however further studies are needed.
