Methane and Hydrogen Mixed SIBO

North Carolina
Has anyone had Methane and Hydrogen mixed SIBO?

I had a lactulose test recently that showed me as very positive for both. The antibiotic treatment regimen seems to be Rifaximin and Neomycin. However, I have read that if the underlying cause of SIBO is not treated, it will not solve the issue. I know that since I have had ME my GI tract is a mess. At first, the diarrhea was horrible. Now, it is just a ton of churning, gas, and intermittent pain. So, is it worth treating SIBO with these antibiotics? Has anyone tried this? What were your results?


Senior Member
So, is it worth treating SIBO with these antibiotics? Has anyone tried this? What were your results?

It's often the case that antibiotics will only temporarily fix SIBO, but after some months relapse occurs.

Here is some general info on SIBO treatment:
Small intestine bacterial overgrowth (SIBO) treatments.

For hydrogen-predominant SIBO, the antibiotic rifaximin 600 to 1600 mg daily for 10 days is effective (higher doses have greater success).1 Rifaximin is a unique antibiotic which remains in the intestines (it is not absorbed into the body). Rifaximin actually increases populations of friendly bacteria like Lactobacillus and Bifidobacterium in the colon,1 and does not lead to bacterial resistance.1

Methane-predominant SIBO is harder to treat, but rifaximin 400 mg three times daily plus metronidazole 400 mg three times daily for 10 days can be used.1 Metronidazole helps kill the methane-producing archaea Alternatively rifaximin 400 mg three times daily plus neomycin 500 mg twice daily for 10 days is effective.1 Neomycin however can harm kidneys, ears (ototoxic), brain and nervous system, and can cause loss of muscle function.1 Having gastrointestinal inflammation may increase the risk of getting toxic effects from neomycin.1

One study found that a physician's elemental diet (to starve the bacteria) for two weeks was highly effective at eradicating SIBO.1 More info here. Homemade elemental diet recipe here.

Herbal treatment of SIBO was shown in one study to be just as effective as antibiotic treatment.1 Herbs used for SIBO include allicin, neem, berberine, oregano oil, cinnamon, cloves, olive leaf extract and red thyme essential oil. Often several herbs are taken together. A study found that the essential oils of cinnamon and winter savory were strongly effective against gut bacteria; aniseed, asafoetida, clove, oregano and thyme essential oils were also good.1

Allicin may be useful for methane-predominant SIBO, as it decreases populations of the archaea in the gut which produce the methane.1 Clove, garlic and oregano essential oils reduce methane production.1

Dietary treatments that reduce food sources for bacteria can bring SIBO under control. Such diets include: the specific carbohydrate diet, the GAPS diet, and the low FODMAP diet. See: Dietary Treatments.

Once the bacterial overgrowth in the small intestine is brought under control by treatment, it is usually necessary to adopt a prevention strategy to stop SIBO from reappearing. Without adopting a prevention strategy, recurrence of SIBO is common.

Prokinetics (these stimulate motility — the movement of food through the digestive tract) help prevent SIBO recurrence. Prokinetics for SIBO include: low-dose naltrexone at bedtime, 2.5 mg for diarrhea SIBO or 5 mg for constipation SIBO; low-dose erythromycin 50 mg at bedtime; prucalopride 0.5 to 1 mg at bedtime; or a natural option is ginger root 1 gram at bedtime.1

Source: ME/CFS roadmap.