Antibiotics For SIBO

Helpful Antibiotics

Although many of my patients find success using diet, probiotics, fasting and herbal therapies to feel better with SIBO there are some times when it is in the patient’s best interest to go right to antibiotic therapy. Prescription antibiotics have the advantage of working quicker than herbal treatments and many are covered by conventional insurance.

It is important to understand that there are several different antibiotics that can be used to treat SIBO.

Unfortunately, I have heard countless patients who were only offered a single course of Rifaximin by their clinician and I hope this information helps you and your doctor find the best treatment for your symptoms.

Rifaximin

This is an excellent and safe antibiotic, and is the most commonly prescribed medication for SIBO. It is taken three times a day for 14 days, and works best at treating cases of SIBO with diarrhea.

In my office, if a patient only gets partial relief after 14 day course, then I commonly consider add on other medications like metronidazole, or natural treatments like garlic or oregano.

A downside is that when it is not covered by insurance, Rifaximin can be prohibitively incredibly expensive.

Tip:

  • Ask your doctor for refills! Back to back treatments are safe, and are sometimes required in more severe cases of SIBO. Insurance typically covers 3 courses a year (the initial prescription plus 2 refills). If your symptoms improve while on the medication, but come back after you’ve finished antibiotics, then you generally need a longer course. Unfortunately, many practitioners aren’t experienced enough with SIBO to realize and the patient fails to get optimally well.

Metronidazole

This medication has been used to treat GI conditions for decades due to its ability to kill anerobic bacteria. One benefit of using this drug is that in addition to addressing the bacteria that cause SIBO it also has activity against a broader range of pathogens (most notably the amoebic parasite Giardia - which can be a missed cause of chronic diarrhea).

  • Used twice a day.

  • Don’t drink alcohol while on this med. This can cause horrible side effects.

  • Works best to clear the types of bacteria that cause increases in methane (CH4)

Amoxicillin

  • A gentle and inexpensive antibiotic that is helpful in reducing symptoms. This antibiotic has very few side effects and is well tolerated and safe in children and adults. This is an excellent option for mild to moderate cases of SIBO.

Antibiotic Combinations

  • Rifaximin and Metronidazole works very well for severe cases of SIBO, especially when the breath test shows high levels of CH4 gas.

  • Amoxicillin and metronidazole is another helpful combination. Although this is used less commonly than Rifaximin and Metronidazole, it is an excellent option when insurance will not cover medications.

Harmful SIBO Antibiotics

Neomycin

This medication is associated with the rare but devastating side effects of permanent hearing loss, irreversible balance issues and kidney failure.

Unfortunately, health gurus and podcasters without medical licenses flippantly talk about the use of neomycin without truly understanding the risks involved.

Making this even worse, these problems can show up years after treatment - making it hard for doctors to understand just how many patient have been permanently hurt by this medication.

For these reasons the FDA has a black box warning associated with oral use of this medication. (Neomycin is safely used topically on the skin). This should be a medication of last resort. I never prescribe this drug for SIBO, the risks are too great and there are many other effective options available to clinicians.

Ciprofloxacin

Cipro is an effective antibiotic that works to clean out a variety of bacteria in the small intestines, and is generally safe for many patients. Unfortunately, this class of medications have been shown to cause a variety of serious problems - notably tendon rupture and irreversible neuropathies. This is why the FDA recommends that Cipro and related drugs should only be used when other options have failed.

In my experience, patients with chronic illness, especially if they have been exposed to environmental toxins are at greatest risk for these problems effects and should be particularly careful.