Prescription Antibiotics - Rifaximin
The most studied antibiotic regimen is:
Note: Rifaximin is unlike most other antibiotics in that it selectively targets the GI tract, so are NOT absorbed by the entire body. That said, they still will wipe out both bad and good actors in the biome.
From a cost perspective, one 10-14 day regimen of Rifaximin can cost upwards of $1k-$2k with insurance.
Prescription Antibiotics - Other
Where Rifaximin is not available for use, the use of rotating antibiotics (e.g., azole and quinolone antibiotics) has shown effectiveness, rather than just one antibiotic alone.https://isitforme.health/browse/dx/sibo/article/34241973
Herbal Antibiotics
Herbal, over-the-counter treatments have not been studied widely, but one small study shows promise.https://isitforme.health/browse/dx/sibo/article/24891990:
From a cost perspective, one round of treatment on these regimens is approximately $100-$200.
Treatment Outcome Expectations
Approximately 45 percent of patients will have recurrent SIBO following completion of antibiotic therapy, with recurrence rates higher in older adults, post-appendectomy, and chronic use of proton pump inhibitors.https://www.ncbi.nlm.nih.gov/books/NBK546634/ In such cases, other overlapping or alternate diagnosis should be considered, such as disaccharide deficiency or food intolerances. For example, a patient with SIBO and lactose intolerance could present with symptoms of gas, bloating, and diarrhea; antibiotics will only confer partial resolution of symptoms. In addition, the patient will require a lactose-free diet. Therefore, a comprehensive assessment of symptoms with appropriate diagnostic tests and careful exclusion of other conditions is important in a patient with risk factors or in those with suboptimal response to therapy. Rigorous controlled studies are needed to guide clinical management. Moreover, other overlapping conditions such as pancreatic exocrine insufficiency, bile acid malabsorption, hormonal oversecretion, medications, functional bloating, hypersensitivity, and factitious symptoms should all be considered as possible causes.https://isitforme.health/browse/dx/sibo/article/31584459
Prokinetics for Motility
Motility disorders are believed to be of major importance in SIBO.https://isitforme.health/browse/dx/sibo/article/8888434 As a result, prokinetics (e.g., erythromycin, ginger https://isitforme.health/browse/dx/sibo/article/30680163) have been identified as helping those patients with an underlying motility disorder.
Diet & Nutrition
More research is being done to identify how diet can treat, prevent recurrence, or aid in healing.
The elemental diet has been identified as potential alternative, post-antibiotic relapse.https://isitforme.health/browse/dx/sibo/article/14992438