Symptomatic patients with small intestinal bacterial overgrowth require targeted treatment to eradicate the overgrowth and resolve gastrointestinal symptoms. The protocol below outlines the evidence-based first-line approach and the clinical goals used to confirm success.
Antibiotic therapy is the cornerstone of treatment for SIBO, directed at eradicating bacterial overgrowth. The protocol identifies several antibiotic agents that may be used — agent selection and full dosing guidance are available in the complete regimen.
Eradication of bacterial overgrowth and resolution of gastrointestinal symptoms (e.g. bloating), confirmed by normalization of the hydrogen breath test (rise below 20 ppm above baseline within 90 minutes).
DOI: 10.14309/ajg.0000000000000501
We suggest the use of antibiotics in symptomatic patients with SIBO to eradicate overgrowth and resolve symptoms (conditional recommendation, low level of evidence).
The use of antibiotics has been the cornerstone of therapy for the treatment of SIBO (Table 5).
In subjects with an abnormal breath test, retesting after treatment may correlate with symptom improvement and may be confirmed by normalization of hydrogen or methane levels.
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