SIBO – Comparing Treatment Options

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There are a number of approaches to treating SIBO. Rifaximin, as discussed previously, is the frontline approach for western biomedicine and as an antibiotic appears less damaging than most. The fact that rifaximin is non-systemic, is minimally absorbed and predominantly stays localised in the gut is promising (1).

Some potential issues with the rifaximin route is a high reported failure rate. One study had success rates of rifaximin alone at 62.1% (2). There are many variables to consider here. The treatment duration could have been too short or the dosage might need to be increased. All considerations.

 

Herbal Medicine or Antibiotics for SIBO Treatment

Let’s look at the paper that compared the suggested antibiotic treatment for SIBO to herbal antimicrobials.

 

First off an incredibly high correlation between SIBO and IBS. The paper quoted a meta-analysis from 2010 that found 54% of people diagnosed with IBS came up positive for SIBO using either a lactulose or a glucose breath test!

From those numbers screening for SIBO when IBS symptoms are present seems wise.

The study compared the popular antibiotic rifaximin, taken at a dose of 1200 mg per day for 30 days, to a selection of herbal medicines, taken 4 capsules per day for the 30 days. The results of the treatment, confirmed by follow up breath tests, showed a 34% success rate in the antibiotic group and a 46% success rate in the herbal group.

Here’s where it gets interesting

A selection of patients from the antibiotic group that still tested positive after the rifaximin treatment received the herbal treatment. From the rescue herbal therapy 57% tested negative for SIBO. This was compared to another set of patients from the same failed rifaximin group (non-responders) that were offered the triple antibiotic therapy. From this group 60% tested negative for SIBO.

 

Comparisons and Conclusions

This study looked into the difference in treatment for SIBO using the antibiotic rifaximin compared to a range of herbs. The study found that the herbal treatment was superior over the 30 day treatment period with a success rate of 46% compared to 34% with the antibiotics.

The crossover aspect of the trial resulted in rifaximin non-responders (people that didn’t clear the SIBO) showed herbal medicine to be 57% successful and the triple antibiotic therapy to be 60% successful.

So what conclusions do we draw from this study? This is the ever present question.

  • Was the intervention period long enough?
  • Were the doses high enough for either intervention?

These questions need to be examined and reflected upon before drawing concrete conclusions but it seems clear that herbal medicine can be as effective, if not more so in some cases, than antibiotic drugs.

We definitely need more of these studies in the future.

 

References and Resources

  1. Rifaximin for small intestinal bacterial overgrowth in patients without irritable bowel syndrome.
  2. Clinical trial: the combination of rifaximin with partially hydrolysed guar gum is more effective than rifaximin alone in eradicating small intestinal bacterial overgrowth.
  3. Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth
  4. Small intestinal bacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis.

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