Thursday, April 11, 2024

Antibiotics Used To Treat Sibo

Benefits Of Treating Sibo With Pharmaceutical Antibiotics

Antibiotics for Treating SIBO

The benefits of pharmaceutical antibiotics include that they have been rigorously studied and tested for safety and effectiveness. Rifaximin, for example, specifically targets the small intestine and has been shown to only minimally impact the microbiome of the large intestine.

When you take pharmaceutical antibiotics, you generally have a good idea of the common side effects. Plus, if your insurance covers pharmaceutical antibiotics, it may be cheaper than shelling out money for over the counter herbal ones.

The Effectiveness Of Antibiotics For Treating Sibo

Depending on which reports you go by, antibiotics are 40% to 91% effective in treating SIBO.1, 4

However, if we look at the long-term effectiveness of antibiotics for treating SIBO, the results are poor. Studies show that recurrence occurs in almost HALF of all patients within one year!3

Considering that antibiotics kill off the healthy bacteria in your gut, the high recurrence rate of SIBO after antibiotic treatment shouldnt be surprising. More importantly, antibiotics do not address the underlying conditions which caused bacteria overgrowth in the first place.

This is why it is so important to take a comprehensive approach to SIBO treatment which includes taking a prokinetic agent , and making changes to your diet and lifestyle. You cant just expect that a hardcore round of antibiotics is going to solve your problems! There is no magic pill for SIBO and that includes antibiotics.

*You must wait 14 days after finishing a round of antibiotics before retesting. This is critical for the accuracy of test! However, dont wait more than 16 days to retest you want to retest before regrowth of bacteria has time to occur.

Remember: these antibiotics require a prescription and Im not a doctor! In the US, these antibiotics are often costly, even with insurance. Since Im uninsured I bought them from an online pharmacy in Canada for 1/10th the cost. Going that route will still require you to have a prescription and might require some patience on the shipping front.

Bacterial Culture Of The Bowel

The bacterial culture of bowel is a direct method of testing using endoscopy to obtain aspirate and culture samples from the small intestine. This test is not commonly used due to the procedure being invasive and requiring endoscopy to obtain a specimen. The results obtained are only indicative of the location where the specimen was obtained and can underestimate the total number of actual bacteria present in other areas of the small bowel.

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Sibo Is Largely Under

The number of people with SIBO in the general population remains unknown. Some studies suggest that between 6 to 15% of healthy, asymptomatic people have SIBO, while up to 80% of people with irritable bowel syndrome have SIBO .

SIBO is largely under-diagnosed. This is because many people dont seek medical care for their SIBO symptoms, and because many doctors arent aware of how common SIBO is. Complicating this, the most commonly used tests still have fairly high rates of false negatives .

The most common symptoms of SIBO include:

  • Abdominal pain/discomfort
  • In more severe cases, there may be weight loss and symptoms related to vitamin deficiencies.

Benefits Of Treating Sibo With Herbal Antibiotics

Metronidazol side effects

The benefits of herbal antibiotics are that many people report having less side effects than pharmaceutical antibiotics. Again, I havent been able to find any actual studies comparing the side effects.

Many people consider herbal antibiotics superior because they are naturalonly you can determine whether that is important to you or not.

One great advantage of herbal antibiotics is that they dont run as high a risk as of antibiotic resistance. Antibiotic resistance happens when bacteria are repeatedly exposed to the same antibiotics and begin to resist survive the treatment more readily, making the antibiotics less effective. This doesnt happen as often with herbal antibiotics so you can use them repeatedly without worrying about antibiotic resistance.

Finally, and I think most importantly, many people cannot find or afford a doctor that knows much about SIBO. Many doctors want you to take antibiotics that have not been shown effective for SIBO. And thats assuming your doctor is even aware of SIBO in the first place!

In these cases, you may need to take your health into your own hands and make the best decision for yourself. That might include treating your SIBO with herbal antibiotics, which you can get over the counter and relatively cheaply. Certain combinations of herbs have been proven in a clinical study by Johns Hopkins to be as effective as Rifaximin for treating SIBO. I explain which combinations later in this post, so keep reading!

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Which Antibiotic Do I Take For Hydrogen Sulfide

Firstly, the good news is that a hydrogen sulfide test is now available in the U.S. If you are positive for H2S, in a training, Dr. Allison Siebecker shared that leading SIBO doctor Dr. Lenny Weinstock has found success with either rifaximin or rifaximin and neomycin, but Siebecker has not experienced the same. Other options to explore would be ciprofloxacin, metronidazole, and aminoglycosides such as vancomycin, to name just a few.

Chronic Idiopathic Intestinal Pseudo

This relatively rare disorder is often first suspected in a patient who has presented with recurrent small intestinal obstruction and typically undergone one or more exploratory surgeries with no mechanical etiology found. In some cases, there is a strong family or genetic history. Familial visceral myopathy is primarily a smooth muscle dysfunction in which gut contraction amplitude and coordination of contraction are reduced. Eventually it affects all gut and genitourinary smooth muscle but may start in the esophagus, duodenum, colon, or urinary tract. Familial visceral neuropathies are also described with both autonomic and enteric neural dysfunction contributing to abnormal gut contractility and transit. Other genetic causes include mitochondrial neurogastrointestinal encephalopathy disease, a multisystem disorder with prominent GI dysfunction and associated neurologic phenotype affects teens and young adults and is caused by a mutation in the gene encoding for thymidine phosphorylase. Nonhereditary causes of chronic idiopathic intestinal pseudoobstruction include scleroderma, paraneoplastic syndromes . In many patients, no obvious cause is apparent and neuromuscular dysmotility is ascribed as a nonspecific descriptor. The lack of specialized centers for interpretation of subtle changes in the enteric nervous system/visceral muscle remains a problem in these cases, even if bowel segments are available for review.

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Is There A Test To Diagnose The Condition

The initial symptoms of small intestine bacterial overgrowth are non-specific and it may take time for the person and health care professional to consider SIBO as a potential cause. The clues may come from illnesses associated with malabsorption of proteins, fats and vitamins. When there is malabsorption it is important to look for SIBO.

Blood tests may be ordered looking for different causes of anemia, electrolyte imbalance, and vitamin deficiencies.

Breath tests may be considered to diagnose SIBO by looking for the byproducts of digestion , especially those produced by bacteria. Upper GI endoscopy allows a gastroenterologist to look at the inside of the upper part of the small intestine and take biopsies or small bits of tissue that can be examined under the microscope. Biopsies can determine if there is damage to the lining of the intestine that may be giving rise to the symptoms either through the mechanism of bacterial overgrowth or via another mechanism.

While these diagnostics tests are being performed, it is appropriate for the health care professional to look for conditions that are associated with SIBO. If such a condition is already known, then maximizing treatment of the associated condition may be undertaken at the same time the diagnosis of which SIBO is being considered and tested.

In addition, underlying vitamin and nutrient deficiencies due to malabsorption should be treated.

Relapse Rates After Sibo Antibiotic Therapy


I think its important to touch on the relapse rates after using antibiotics for SIBO. This helps you make the decision whether to try natural treatments initially or go straight to antibiotics, especially if you have to do multiple courses.

I think you will find that in the long run, its important to incorporate a mostly natural strategy, only using pharmaceuticals when your symptoms are very severe.

In this study, the aim was to investigate SIBO recurrence in patients after successful antibiotic treatment. They took 80 patients treated with Xifaxan and reassessed them 3, 6, and 9 months after their breath tests normalized. The results are informative and very important for people who use antibiotics to understand.

The Results:

  • 3 months after successful antibiotic treatment 10 patients tested positive for SIBO again indicating relapse
  • 6 months after successful antibiotic treatment 22 patients tested positive for SIBO
  • 9 months after successful antibiotic treatment 35 patients tested positive for SIBO

They also showed that being older, having your appendix out, and chronically using proton pump inhibitors increased the chance of relapse. This means that if you have other health issues that are affecting your gut function you will be more likely to relapse and become a chronic SIBO patient.

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But Dont Antibiotics Cause Sibo

It is ironic that antibiotics are used to treat SIBO, because one of the main causes of SIBO is antibiotic use.

Antibiotics cant tell the difference between the healthy bacteria in your body and the harmful bacteria. They also cant determine healthy levels of bacteria .

When you take an antibiotic, whether for SIBO or another condition, it will indiscriminately kill off all bacteria including the good guys.

The good bacteria in our guts have many roles, including keeping the bad guys in check. Without enough good guys, the bad guys can quickly get out of control. So, those antibiotics for SIBO might temporarily get rid of the harmful bacteria, but it will probably just come back since you also killed off the good guys too! Hence why SIBO has such a high recurrence rate.

How To Treat Sibo + Manage Naturally

Small intestinal bacterial overgrowth is defined as the presence of an abnormally high number of coliform bacteria in the small bowel. First, make sure youve read part 1 of this blog: Understanding Sibo, which goes into understanding the condition, the symptoms, and how to properly diagnose it.

So, you have SIBO or suspect you do, and you are most likely REALLY confused. This blog is going to cover treatment options, how to manage it, diet recommendations, and what to avoid.

You can assume you have SIBO, but without the actual test results from a lactulose breath test, you dont know whether you are hydrogen or methane dominant. As I covered in Understanding SIbo, the bacteria in your small intestine release either hydrogen or methane gases when they consume undigested food particles. Its important to know which version you have as that can effect treatment.

MONEY SAVING TIP: The good news is, you can usually request a lactulose breath test from your regular Gastroenterologist now, and so it will be covered on most insurance. But, YOU WILL HAVE TO ASK. Otherwise, theyll say you have IBS and send you on your way.

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Sibo Testing And Diagnosis

Diagnosing small intestinal bowel overgrowth includes obtaining a comprehensive medical, surgical and symptom history to identify risk factors and symptoms that may be suggestive of bacterial overgrowth. The physical exam will help your child’s physician evaluate for malabsorption and underlying disorders that have been linked to an increased risk for SIBO.

Diagnostic screening testing may include imaging of the abdomen and bowel to evaluate for dilated loops of bowel and screen for any areas of narrowing of the bowel causing decreased motility through the intestines.

Diagnostic testing for SIBO may also include:

  • Bacterial culture of the bowel
  • Hydrogen breath test

Are Prebiotics The New Probiotics For Sibo

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The story with prebiotics is pretty similar to that of probiotics for SIBO. Prebiotics are actually the fuel that feeds bacteria. This means if you still have an overgrowth, it will fuel it, which is why they often aggravate symptoms if eaten during treatment. Raw chicory root, Jerusalem artichoke, dandelion greens, leeks, garlic and onion are all examples of prebiotic-rich foods.

However, once the overgrowth has been eradicated, feeding the good guys and encouraging the right balance of flora is an important part of the long-term healing journey. There is obviously a delicate balance here and prebiotics are something that needs to be introduced slowly.

As with many complicated conditions, there is also a subset of clients who seem to thrive on prebiotics during and after natural SIBO treatment, something that is not yet well understood but will hopefully become clearer over time. It just highlights the point that what works for some people, will make things worse for others .

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Medications I Used When I Treated My Sibo

Depending on who you ask you may get some very different answers for how to treat SIBO. There are pharmaceutical antibiotics, natural antibiotics, or the elemental diet. Not to mention countless other supplements, diets, or protocols that people swear by.

My gastroenterologist trained under Dr. Mark Pimentel, one of the foremost SIBO experts, at Cedars-Sinai Hospital in Los Angeles. His approach basically mimics what Dr. Pimentel recommends. I had read up on this protocol beforehand, so I was pleased when my doctor recommended it without me having to educate him.

My doctor prescribed me a 14 day course of the antibiotics Rifaximin and Neomycin. My breath test showed both hydrogen and methane, and this combination is very effective when treating both. Using Metronidazole instead of Neomycin also been shown to be effective.

I took the Rifaximin three times a day in 550mg doses for a total of 1,650mg per day. The Neomycin I took twice a day , in doses of 500mg for a total of 1,000mg per day.

I set a timer on my phone to remind me to take them, because its a lot of medication to be taking all the time! I also found it pretty annoying to have to remember to take the bottles with me when I went to work.

Which Antibiotic Do I Take For Hydrogen

Rifaximin treats hydrogen and is reportedly the most successful, according to many experts. Rifaximin can be expensive, depending on your health insurer, but alternative options could be explored, such as metronidazole.

If you have constipation rather than diarrhea, you may want to consider following the protocol for methane, mentioned below.

Its also worth noting that some of these antibiotics go by different names in different countries.

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Associated Sibo: Types Of Other Diseases Or Conditions Associated With It

Small intestine bowel overgrowth is often associated with another illness that affects the function of the small intestine. The body has many protective mechanisms to keep bacteria under control, including stomach acidity and intestinal motility, the ability for the intestine to move its contents downstream at an appropriate speed. Bacterial growth is hindered by the presence of bile and immunoglobulins. Finally, the ileocecal valve prevents stool from refluxing from the colon into the ileum or the last part of the small intestine.

Any illness or disease that affects the body’s defense mechanism puts a person at risk for SIBO, but the majority of people develop SIBO because of an intestinal motility problem. These may include

A person with SIBO does not need to have all of these symptoms.

As the disease progresses, the bacterial overgrowth inhibits the body’s ability to properly absorb nutrients from the diet. This can lead to vitamin and electrolyte abnormalities, protein deficiencies, and difficulties with fat absorption.

Inability to absorb vitamin B12 can lead to symptoms of pernicious anemia, including a low red blood cell count and peripheral neuropathy. Anemia also may be due to iron deficiency. Decreased Vitamin A may lead to night blindness. Metabolic bone disease may be due to Vitamin D deficiency and decreased calcium. This may also lead to muscle twitching and spasms.

Common Risk Factors For Sibo

Antibiotics for SIBO? There is a better way!

Researchers suspect SIBO is caused by a combination of decreased pancreatic enzymes, bile acids and gut motility.

Consequently, certain health conditions or lifestyle choices may increase your risk of developing SIBO:

  • Gastrointestinal infections: Such as post-infectious IBS
  • Chronic use of antacids: Long-term antacid use reduces acid production in the stomach. Consistently low levels of stomach acid can lead to bacterial overgrowth in the stomach and small intestine .
  • Immunodeficiency Syndrome: Disorders that can suppress our immune system such as AIDS and IgA antibody deficiency provide an ideal environment for harmful bacteria to thrive .
  • Celiac disease:Celiac disease can disturb how food moves through the intestines, particularly if it remains undiagnosed or is poorly managed. This leads to increased bacterial growth in the gut .
  • Aging: In general, older people are at increased risk for SIBO because our digestive tract gets weaker with age. This is thought to be caused by reduced physical activity, weight gain, ongoing medication use and general weakening of the gastrointestinal tract .
  • Alcoholism: Chronic alcohol consumption appears to increase risk of SIBO .
  • Gastroparesis: There is a strong overlap between symptoms, and it seems those with gastroparesis are more likely to have SIBO .

Summary: Your risk of SIBO is greatly increased by several conditions and factors, most often related to reduced function and efficiency of the intestines.


  • Fatigue

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The Methane Sibo Constipation Connection

So, even though archaea help reduce the amount of hydrogen gas in our small intestine, the methane they produce can have its own negative effects. As with hydrogen in the small intestine, methane gas will also cause abdominal bloating, plus a much bigger problem it slows down transit time which leads to constipation.

Research has also shown that the higher the methane gas elevation, the more severe constipation becomes.

While you might think SIBO constipation is preferable to diarrhea, and symptomatically in the short-term you might be right, constipation caused by these methanogens can create a vicious cycle of SIBO that is harder to break than the traditional SIBO-D, diarrhea type. This was my issue, and the cause of lots of my healing struggles, so let me explain some more.

You see, methane slows transit time and causes constipation, and constipation allows more bacteria to grow, which causes more methane and more constipation and so on, and so forth. SIBO constipation is a difficult cycle to break without the right intervention.

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