Are you feeling totally overwhelmed about your SIBO treatment options?

There are three specific treatment options for SIBO: antibiotics, antimicrobial herbs, and the elemental diet. To help you make your decision, today I’ll take you through antibiotics. As always, remember that each person is different, so make sure to consult with your SIBO doctor or other members of your healthcare team before making any treatment decisions.

What are the main antibiotics?

The main SIBO antibiotics are rifaximin, metronidazole, and neomycin. Other antibiotics are sometimes used if these three aren’t possible, but these are generally regarded as the best options.

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.

It’s also worth noting that some of these antibiotics go by different names in different countries.

Which antibiotic do I take for methane (renamed to intestinal methanogen overgrowth)?

Methane is notoriously harder to treat, so you need to combine rifaximin with metronidazole or neomycin. If you have both gas types present, this also is the protocol.

Again, there are some alternatives, but not many. Nitazoxanide could be worth trying.

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.

How long do you need to take antibiotics?

A treatment round would be two weeks, perhaps three weeks if you had gas levels higher than 55 parts per million. This reduces the SIBO by an average of 30 ppm. This means that if your gas levels reached 100 ppm in your results, you’d need up to four rounds of antibiotics.

What are the benefits of antibiotics?

Siebecker shared in our training course that antibiotics have a 70-73% success rate on average, sometimes reaching as high as 91%.

They can also be a better option for more sensitive patients, because doctors and SIBO specialists generally see less die-off with them. Die-off occurs when lots of bacteria (or fungus) die at the same time. As they break down, their cell walls are exposed and cause intense aggravation to our immune system, causing — ironically — worsening SIBO symptoms or flu-like symptoms.

Rifaximin has many benefits. It’s not your typical antibiotic and stays local, meaning it mainly works in the small intestine, where SIBO is present and doesn’t affect the large intestine microbiome. It’s also anti-inflammatory and even increases glutamine, which helps to heal leaky gut!

What are the risks and side effects?

Neomycin affects both the small and large intestine, and metronidazole affects the entire body. This means that your good gut bacteria will also be killed off, so you’ll have to do some work on rebuilding it post-treatment.

Another consideration is yeast overgrowth. Because antibiotics kill off bacteria, they allow room for yeast to increase as certain bacteria help to keep yeast in check. This can be a problem because candida (yeast) or other fungi are often present in SIBO patients, and symptoms can seem almost identical.

Rifaximin doesn’t cause this side effect, whereas neomycin and metronidazole both can, due to being conventional antibiotics. However, combining one of these two with rifaximin will help lessen the chances of yeast overgrowth, and you can additionally add an anti-fungal treatment such as an antimicrobial herb to kill off any yeast. It also can be helpful to do a test called a GIMap ahead of treatment to give you an idea of any candida overgrowth already present.

It’s worth noting that resistance is possible. Resistance is when the SIBO bacteria change to resist the effects of the antibiotics, and as a result, the antibiotics no longer work.

As always, the star here, rifaximin, shines through and is unlikely to cause any resistance. Neomycin on the other hand, is known for causing resistance, but combining with rifaximin can lessen the effect. Ideally, you’ll need to work closely with your SIBO doctor to keep an eye on resistance signs.

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