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.
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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.
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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.
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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.
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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.
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