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Antibiotic Treatment of Small Intestinal Bacterial Overgrowth: What Is the Evidence?

Schwartz, Emily MS, RD, CNSC; Brunetti, Luigi PharmD, BCPS, CGP; Ziegler, Jane DCN, RD, LDN

doi: 10.1097/TIN.0000000000000081
Review Articles

Small intestinal bacterial overgrowth (SIBO) is characterized by an abnormally high concentration of bacteria in the small bowel, and is often associated with abdominal pain, bloating, and/or stool changes. Antibiotics, prebiotics, and probiotics have been considered as treatment options for individuals with SIBO. The aim of this literature review was to evaluate the evidence supporting antibiotic therapy for SIBO treatment. A systematic search of PubMed, Cochrane Library, and Web of Science databases was performed, and 13 studies were included for analysis. The analysis of the available data suggests that antibiotics, particularly rifaximin, may be effective in normalizing breath tests and improving gastrointestinal symptoms in patients with SIBO.

Touchpoint Support Services, Providence Park Hospital, Novi, Michigan (Ms Schwartz); Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey (Dr Brunetti); and Rutgers University, New Brunswick, New Jersey (Ms Schwartz and Dr Ziegler).

Correspondence: Emily Schwartz, MS, RD, CNSC, Clinical Dietitian, Touchpoint Support Services, Providence Park Hospital, Novi MI 48374 (

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

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