SIBO Treatment: Antibiotics and Diet Changes to try

SIBO Treatment: Antibiotics and Diet Changes to Try

Are you or someone you know dealing with the symptoms of Small Intestinal Bacterial Overgrowth (SIBO)? This condition can be quite bothersome, but the good news is that it can be managed with the right approach.

A combination of antibiotics and dietary changes has proven to be effective in treating SIBO.

Antibiotics help reduce bacterial overgrowth in the small intestine, while dietary interventions can help avoid trigger foods that may exacerbate symptoms.

In this article, we will delve deeper into the commonly prescribed antibiotics for SIBO treatment and the diet changes that can aid in your recovery.

Antibiotics: A Key Component in SIBO Treatment

Antibiotics play a crucial role in the treatment of SIBO. They work by reducing the number of bacteria in the small intestine. It is important to understand that not all antibiotics are suitable for treating SIBO. , as Some antibiotics can actually lead to an increase in bacterial overgrowth. Therefore, it is crucial to be prescribed the right kind of antibiotics by a healthcare professional.

Commonly Prescribed Antibiotics for SIBO

Some of the commonly prescribed antibiotics for SIBO treatment include Rifaximin, Neomycin, and Metronidazole. Rifaximin is often the first choice of treatment as it is specifically targeted toward the gastrointestinal tract and has minimal systemic absorption.

Neomycin and Metronidazole are other options that may be prescribed in combination with Rifaximin or alone, depending on the severity of the condition.

Diet Changes: An Essential Part of the Recovery Process

Along with antibiotics, making changes to your diet is essential for managing SIBO. Certain foods can trigger symptoms or contribute to bacterial overgrowth in the small intestine.

It is often recommended to follow a low-FODMAP diet, which restricts the intake of fermentable carbohydrates that are poorly absorbed in the small intestine. The unwanted bacteria in the small intestine thrive off of fermentable carbohydrates. Limiting or avoiding them helps to reducethe "food" available for bacterial fermentation and subsequently, the production of gas, which causes bloating and other symptoms.


Managing SIBO requires a multifaceted approach that includes antibiotics and dietary changes. A combination of these approaches can lead to a successful recovery from SIBO. It is always advisable to consult with a healthcare professional before starting any new treatment regimen.

Antibiotic Therapy

One of the mainstays of SIBO treatment is antibiotic therapy. Let's take a closer look at the antibiotics commonly prescribed for SIBO and why Xifaxan (Rifaximin) is often considered the first course of treatment.

Antibiotics Commonly Prescribed to Treat SIBO

Various antibiotics are used in SIBO treatment, including Flagyl (metronidazole), Cipro (ciprofloxacin), Tetracycline, Amoxicillin-clavulanate, Neomycin, Norfloxacin, and Xifaxan (rifaximin).

Xifaxan (rifaximin) is the most studied antibiotic for SIBO and is often the first choice of treatment. However, there may be alternatives such as metronidazole and ciprofloxacin that can be used based on the patient's specific needs and medical history.

Xifaxan: First Course of Treatment

Xifaxan, also known as rifaximin, is commonly used as the first course of treatment for SIBO because of its unique benefits. It acts directly on the bacteria in the small intestine, reducing the bacterial overgrowth without having a significant impact on the bacteria in the large intestine.

This selective action helps in managing SIBO while minimizing the disruption of the gut microbiome. Xifaxan is usually prescribed in courses of two weeks, and higher dosages have been found to be more effective. While Xifaxan is generally well-tolerated, some possible side effects include nausea, dizziness, and fatigue.

Dietary Interventions

While antibiotics are essential for managing SIBO, dietary interventions are equally important. Modifying your diet not only helps in managing the symptoms but also supports the overall healing process.

Let's delve into the potential nutritional deficiencies that can result from SIBO, the elemental diet as a last resort treatment, the low-FODMAP diet, and the important considerations before making any dietary changes.

Nutritional Deficiencies

SIBO can lead to various nutritional deficiencies as the overgrowth of bacteria in the small intestine interferes with the absorption of nutrients. It is crucial to identify and treat any deficiencies to support overall health and well-being.

Common deficiencies associated with SIBO include vitamin B12, fat-soluble vitamins (A, D, E, K), and iron. A healthcare professional can help identify any nutritional deficiencies through blood tests and recommend appropriate supplements or dietary changes.

The Low-FODMAP Diet

The low-FODMAP diet plays a crucial role in treating SIBO. It works by reducing the consumption of fermentable carbohydrates that can feed bacteria in the small intestine.

Common high-FODMAP foods that should be avoided on this diet include:

  • Wheat
  • Onions
  • Garlic
  • Certain fruits and vegetables

Instead, focus on consuming low-FODMAP foods like lean proteins, eggs, and certain fruits and vegetables such as strawberries, oranges, and zucchini.

It’s also advised to avoid foods and drinks containing artificial sweeteners as they can contribute to bacterial overgrowth.

Paleo Diet

Another dietary approach to treating SIBO is a paleo-type diet. Paleo diets focus mainly on eating protein, vegetables, and some fruits and eliminate grains, legumes, seed oils, and dairy products. Many people with IBS and SIBO find relief when they remove dairy and grains, particularly gluten, from their diet.

Paleo diets are lower in carbohydrates which helps starve out the bacteria in the small intestine.

Elemental Diet

The elemental diet is a last-resort treatment for SIBO patients who are not responding to antibiotics or dietary changes. It involves limiting food intake to three nutrition shakes a day that replace sugars, fats, and proteins with glucose, fatty acids, and amino acids. The shakes are extremely easy to digest and give the small intestine a chance to rest and heal.

They also help starve the bacteria of their food supply, thereby aiding in the reduction of bacterial overgrowth. The elemental diet is usually followed for two to three weeks under the guidance of a healthcare professional.

Some research has shown that a modified or "half" elemental diet can also be beneficial. In this case, a person would drink one or two shakes a day and be able to eat one meal a day.

Before You Change Your Diet

Before making any dietary changes, it is important to consider the potential impact on SIBO symptoms and bacterial overgrowth. Key factors to consider include any existing medical conditions, nutritional deficiencies, and other gastrointestinal diseases.

It is always advisable to consult with a healthcare professional before starting any new diet regimen to ensure it is appropriate for your specific situation and will not inadvertently exacerbate your condition.

Address Underlying Issues

Apart from bacterial overgrowth, there are several underlying issues that can contribute to the development of SIBO. Addressing these issues is a crucial part of the treatment process.

This section will discuss diseases that affect the small intestine, structural problems, and medication side effects that can contribute to the onset of SIBO.

Diseases that Affect the Small Intestine

Several diseases can affect the small intestine and contribute to the onset of SIBO, including Gastroparesis, Celiac Disease, and Inflammatory Bowel Diseases (Crohn's disease and Ulcerative Colitis).

These conditions can impair digestion and lead to symptoms such as bloating and abdominal pain.

Gastroparesis slows down the movement of food through the digestive tract, mainly the stomach, Celiac Disease damages the lining of the small intestine, and Inflammatory Bowel Diseases cause chronic inflammation and ulcers in the digestive tract.

Structural Problems

Various structural problems can contribute to the development of SIBO, such as blind loops, bowel obstruction, diverticula in the small intestine, fistulas, Crohn's disease of the small bowel, strictures, and post-partial colectomy complications.

These structural abnormalities can slow down the movement of food and bacteria through the small intestine, creating an environment conducive to bacterial overgrowth.

Medication Side Effects

Certain medications can contribute to the development of SIBO. Opiates, which slow down bowel movements, and proton pump inhibitors, which decrease stomach acid production, are common culprits.

Stomach acid helps kill bacteria in the food we eat before it reaches the small intestine. By reducing stomach acid, proton pump inhibitors can inadvertently allow more bacteria to enter the small intestine.

Discontinuing these drugs, under the supervision of a healthcare professional, may help reduce SIBO symptoms.

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The Future of SIBO Treatment

As research advances, new treatment options for SIBO are emerging. Apart from antibiotics and dietary interventions, herbal formulations, prokinetic medications (stimulate the digestive tract), and probiotics are gaining traction as potential treatment options.

Each of these alternatives addresses different aspects of SIBO and can be considered as part of a comprehensive treatment plan.

Herbal Formulations

Herbal formulations are becoming increasingly popular in the treatment of SIBO. Certain herbs have been found to help reduce bacterial overgrowth in the digestive tract.

Herbal antibiotics such as berberine, oregano oil, and garlic have shown potential benefits and effectiveness in reducing bacterial overgrowth.

However, it is essential to note that while herbal antibiotics can be effective, they should be used under the guidance of a healthcare professional as part of a comprehensive treatment plan.

Prokinetic Medications

Prokinetic medications are another promising avenue for the treatment of SIBO. These medications work by improving gastrointestinal motility, thereby helping to move food and bacteria through the small intestine more effectively and reducing the opportunity for bacterial overgrowth.

Commonly prescribed prokinetic medications for SIBO treatment include low-dose naltrexone (LDN), erythromycin, and prucalopride. Some natural prokinetics are available as well and include ginger, curcumin, melatonin, and peppermint oil.


Probiotics are live bacteria and yeasts that are beneficial for our digestive system. While research on the effectiveness of probiotics in treating SIBO is limited, there have been positive findings in some studies.

Probiotics can help restore the balance of gut bacteria, improve the fermentation patterns in the small intestine, and may be considered after completing the antibiotic protocol and a low FODMAP diet.

However, it is essential to approach probiotics with caution and under the guidance of a healthcare professional as they may not be suitable for everyone.

Preventing Relapse

After successfully treating SIBO, it's crucial to take steps to prevent a relapse of symptoms and maintain gut health.

A crucial component of this is dietary modifications. Following a low-FODMAP diet and avoiding trigger foods can help keep the bacterial balance in check and prevent an overgrowth from reoccurring.

Additionally, it's important to consider other measures, such as retesting for underlying imbalances, addressing mold or yeast in the large intestine, and managing other conditions associated with SIBO, like Celiac Disease or Crohn's Disease.

It’s also important to note that managing stress and maintaining a healthy lifestyle can play a significant role in preventing a SIBO relapse.

Closing Thoughts

In conclusion, Small Intestinal Bacterial Overgrowth (SIBO) is a condition that involves an overgrowth of bacteria in the small intestine, leading to symptoms such as bloating, abdominal pain, and nutritional deficiencies.

The main approach to treating SIBO involves a combination of antibiotics to reduce bacterial overgrowth and dietary interventions to avoid trigger foods and support overall health.

Several antibiotics, such as Xifaxan, metronidazole, and ciprofloxacin, are commonly prescribed to treat SIBO. However, it is also essential to address potential nutritional deficiencies, implement dietary changes like the low-FODMAP and Elemental diets, and manage any associated conditions or underlying issues to prevent relapse and maintain gut health.

Remember, it's important to consult with a healthcare professional before starting any new treatment regimen. They can provide a comprehensive plan tailored to your specific needs and help monitor your progress throughout the treatment. With the right approach, it is possible to manage SIBO effectively and maintain long-term gut health.

Frequently Asked Questions

It's natural to have questions when considering treatment options for Small Intestinal Bacterial Overgrowth (SIBO). Here, we will address some frequently asked questions about Xifaxan, a commonly prescribed antibiotic for SIBO treatment, to help you make an informed decision about your health.

What is Xifaxan?

Xifaxan is a brand name for the generic drug rifaximin, an antibiotic that works primarily in the intestine to reduce harmful bacteria. Although Xifaxan is not FDA-approved specifically for SIBO, it has been shown to improve symptoms in clinical trials, making it a popular choice among healthcare professionals for SIBO treatment.

Will Xifaxan help SIBO?

Xifaxan has demonstrated efficacy in treating SIBO by reducing the overgrowth of bacteria in the small intestine. Success rates and duration of treatment can vary based on the individual and the severity of their condition. It is generally prescribed in courses of two weeks, with higher dosages being more effective.

However, like all medications, Xifaxan has potential side effects, including nausea, diarrhea, and abdominal pain. It's important to discuss these potential risks with your healthcare provider to determine if Xifaxan is the right treatment option for you.

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