SIBO is caused by an overgrowth of bacteria in your small intestine, so it would make sense to treat it with antibiotics – right? While antibiotics may be an integral part of the SIBO treatment process, antibiotics alone rarely cure SIBO in the long term. Here we will talk about which antibiotics can be used for treating SIBO and why you shouldn’t rely solely on them to overcome SIBO.
This article is part of a series on treating SIBO. If you missed the last parts of the series, read them here:
- Part 1: What is SIBO?
- Part 2: Symptoms of SIBO
- Part 3: Causes of SIBO
- Part 4: Diagnosing SIBO
- Part 5: Breath Tests for SIBO
- Part 6: Hydrogen vs. Methane SIBO
What Antibiotics Are Used for Treating SIBO?
There are two antibiotics which are mainly used for treating SIBO: Rifaximin (generic: Xifaxan) and Neomycin (in the case of methane-dominant SIBO). The reason these are chosen is because they are non-systemic, meaning they mostly don’t get absorbed into the bloodstream and instead stay in the intestines, allowing them to kill bacteria residing in the intestines and not elsewhere.
Less frequently, the systemic antibiotic (meaning it does get into your blood and circulate through your body) Metronidazole is prescribed.1 Generally, doctors will prescribe these antibiotics for 10 to 14 day courses.2
At siboinfo.com, Dr. Siebecker (a leading expert on SIBO) gives these as some examples of SIBO dosage options. Keep in mind that there aren’t any established protocols for SIBO antibiotic dosages, so your doctor may prescribe something different1:
- Rifaximin 1600mg daily x 10 days
- Rifaximin 1200mg daily x 14 days
- Rifaximin 1600mg daily + Neomycin 1000mg daily x 10 days
- Rifaximin 1600mg daily + Metronidazole 750mg daily x 10 days
Oftentimes, a single round with one of these antibiotics doesn’t cure SIBO, especially in severe cases.3 When the first course doesn’t work, doctors will often prescribe another antibiotic or add another antibiotic to the treatment for another course.
For me, one 14 day course of Rifaximin + Neomycin didn’t even come close to eradicating SIBO. I later learned that based on my severe case it likely would have taken FOUR (expletive deleted) rounds!
But Don’t Antibiotics Cause SIBO?
It is ironic that antibiotics are used to treat SIBO, because one of the main causes of SIBO is antibiotic use.
Antibiotics can’t tell the difference between the “healthy” bacteria in your body and the “harmful” bacteria. They also can’t determine healthy levels of bacteria (remember, SIBO can sometimes be caused by too much of the healthy bacteria which should be in your gut!).
When you take an antibiotic, whether for SIBO or another condition, it will indiscriminately kill off all bacteria – including the good guys.
The good bacteria in our guts have many roles, including keeping the “bad guys” in check. Without enough good guys, the bad guys can quickly get out of control. So, those antibiotics for SIBO might temporarily get rid of the harmful bacteria, but it will probably just come back since you also killed off the good guys too! Hence why SIBO has such a high recurrence rate.
The (In)Effectiveness of Antibiotics for Treating SIBO
Depending on which reports you go by, antibiotics are 40% to 91% effective in treating SIBO.1, 4
However, if we look at the long-term effectiveness of antibiotics for treating SIBO, the results are poor. Studies show that recurrence occurs in almost HALF of all patients within one year!3
Considering that antibiotics kill off the healthy bacteria in your gut, the high recurrence rate of SIBO after antibiotic treatment shouldn’t be surprising. More importantly, antibiotics do not address the underlying conditions which caused bacteria overgrowth in the first place.
This is why it is so important to take a comprehensive approach to SIBO treatment which includes taking a prokinetic agent (which we will talk about later), and making changes to your diet and lifestyle. You can’t just expect that a hardcore round of antibiotics is going to solve your problems! There is no magic pill for SIBO and that includes antibiotics.
*You must wait 14 days after finishing a round of antibiotics (even herbal antibiotics) before retesting. This is critical for the accuracy of test! However, don’t wait more than 16 days to retest; you want to retest before regrowth of bacteria (recurrence) has time to occur.
Remember: these antibiotics require a prescription and I’m not a doctor! In the US, these antibiotics are often costly, even with insurance. Since I’m uninsured I bought them (legally) from an online pharmacy in Canada for 1/10th the cost. Going that route will still require you to have a prescription and might require some patience on the shipping front.
In the next articles of this series, we will talk about other methods of treating SIBO (and beating it food good!), including herbal antibiotics, dietary changes, healing the gut lining, and supplements for SIBO.
Ready to eliminate SIBO once and for all? Get your copy of The SIBO Solution: Your Comprehensive Guide to Eliminating Small Intestinal Bacterial Overgrowth by clicking HERE. You’ll also receive a BONUS SIBO Detox Support Guide mini ebook with your purchase.
Latest posts by Sylvie McCracken (see all)
- Treating H. Pylori (Part 3): What H. Pylori Does to the Body - August 8, 2022
- Treating H. Pylori (Part 2): How H. Pylori is Contracted - August 3, 2022
- Understanding Beef Labels: Organic, Pastured, Grass-Fed & Grain-Finished - July 25, 2022
Hello Sylvie,
I’ve done several things for my SIBO with no improvement. I have a good diet a good health in general & assume my SIBO was caused my antibiotic use. Did some herbal antibiotics (berberis formula, then oil of oregano) & low Fodmap diet with no symptom improvement. Then did elemental diet & numbers actually increased. I actually felt some symptom improvement, but when I retested 3 weeks later, numbers were higher. H went from 78 to 94. I’m baffled. So is my ND. Then did a round of Allicin & Neem oil. I’ve felt no symptom improvement and a month later now feeling like things are getting worse. Dr. wants me to do Rifaximin or ED again. The ED was so horrible, I don’t think I can get through it again. And it doesn’t sound like Rifaximin is very effective. Would it be useful to do more rounds of herbal antibiotics? If so, which ones and how long on each?
Thanks,
Nicole
Sylvie I’m confused on something here –
We’re supposed to use probiotics immediately after antibiotic/natural antibiotic treatment. From what you wrote above in regard to retesting, “don’t retest until 14 days after treatment, but don’t wait longer than 16 days.”
Most SIBO test recs say “Don’t take probiotics for 1 week prior to treatment” otherwise your test results will not be accurate.
So do we take probiotics for just 7 days, then go off of them for 7 days, then restart them after being retested?
HI Sylvie
I got my SIBO after pancreatitis, Im wondering if it was due to lack of enzymes and if trying to fight this is even worth it. I take enzymes but it doesn’t help. My symptoms are pain and bloating after any meal. I cannot eat anything with fat or oil in it due to pancreatitis. DO you think you could still help me?
Kindest Regards
Candice
Hi Sylvie, I’m in the U.K. and was diagnosed with high methane levels in Dec. Took Rifaximin for 10 days but don’t feel much different. Still bloated and constipated. Dr won’t retest and says I just have IBS and has prescribed a drug to help with constipation. Linaclotide.
Saw a naturopath and she has given me oil of oregano and some digestive enzymes and suggested low Fodmapdiet. I tried the lowfodmap diet last year and it didn’t make much difference so I’m looking for some dietary advice. Esp with breakfast- they need to be quick. Thanks
I have read slow motility is a catributing factor….I believe this my root cause….I have terrible Motility due to a neuromuscular disorder….its been a difficult journey and also not easy to.find a knowledgeable specialist…so frustrating..
Hi Sylvie,
Thank you very much for the SIBO diet list and the wonderful website which has been very helpful to me. I’ve been suffering with horrible bloating, pain, distended abdomen, B12 deficiency, depression, constipation, chronic fatigue, etc. for many years and I want to try the antibiotics with diet and prokinetics. My doctor here in Romania has agreed to help me with prescriptions but neomycin tablets is not available in Romania or Hungary and no luck so far with online pharmacies.
Any suggestion would be greatly appreciated.
Thanks, Doru
I have no insurance but found a cash doctor who will prescribe what I feel I need. I asked for Rifaximin 550 mg 3xday for 2 weeks. I was told years ago I had sibo by dr but I blew it off. Now I’m about done w my round and kept reading and realized I have constipation with mine and should have asked for the neomycin. Question is, can I take a round of neomycin when done w Rifaximin in 3 days along w a prokenetic to kill the methane producers? At the same time following the low god pls and scd?
I go to the dr tomorrow and can ask for prescriptions for neomycin and resalor.
My pharmacy had a 1000.00 coupon. You can also call the company and they will give you one.
Hi Sylvie, so you did take generic version of rifaximine from india,did it work for you?
I ask because i took generic rifaximine from india ,first days it was working like magic ,but i kept eating everything like suggested and i developed resistance to generic rifaximine very fast till it stop working in few days, Dr Siebecker in her inverview say that indian rifaximine has different ingredient in it,that can be the reason for fast resistance to it.
Thanks SO much, Sylvie! I really appreciate that! Just hoping it will do the trick and take care of the SIBO, as I’m losing patience with it. Have a great day, and thanks again!! 🙂
Sure thing Kristin! Just checked my receipt and it was $136 from PlanetDrugsDirect.com
Looks like a dodgy site but they simply asked for my prescription and I received the abx in the mail. Easy peasy. If I remember correctly the shipping wasn’t the fastest in the world but probably worth the wait to save almost $900! 🙂
Hope that helps!
Sylvie
Hi Sylvie, Are you able to tell me the name of the pharmacy in Canada from which you ordered the rifaximin? I too have a prescription, but my insurance will not cover it. I’d like to find a viable option to the $1,000 price tag! Thanks so much!
Sure thing Kristin! Just checked my receipt and it was $136 from PlanetDrugsDirect.com
Looks like a dodgy site but they simply asked for my prescription and I received the abx in the mail. Easy peasy. If I remember correctly the shipping wasn’t the fastest in the world but probably worth the wait to save almost $900! 🙂
Hope that helps!
Sylvie
Thanks SO much, Sylvie! I really appreciate that! Just hoping it will do the trick and take care of the SIBO, as I’m losing patience with it. Have a great day, and thanks again!! 🙂
Dear Sylvie; you’re definitely God sent for me coz I live in the Sub continent and have been struggling with GI related issues since my childhood. I’m pretty sure I’ve SIBO but there’s no way for me to confirm it since there are no breath tests available for it. But I’ve most of its symptoms and my doubts were confirmed recently when my symptoms enormously reduced during my H-pylori 14 days antibiotics course and came back after 2 weeks. Although I wud want to eradicate SIBO by using herbs but unfortunately I don’t have access to the herbal antibiotics you’ve mentioned in your blog. I keep using hit and trial with some herbs that I get to find here such as Oregano oil, Grapefruit Seed Extract, Turneric but now I feel that I’d go with Rifaxamin and then will use Erthromycin as a pro kinetic afterwards. Can you be kind enough to let me know how long should I be taking it after I finish my antibiotics course. Many thanks and blessings; you’re great!!:) Zahra
Hi Zahra,
Glad you’re loving the blog 🙂
It sounds like Rifaximin is the best (or only) solution for you. You might want to add Neomycin (if available) if you have SIBO-C which will likely be methane dominant (guessing, since you can’t test).
For the prokinetics, I would check with your doc, but I would take them immediately after finishing your course of antibiotics and for several months after.
The only thing is that I’m not sure if 1 course of antibiotics will be enough to eradicate but it’s definitely a good start and much better than nothing.
Sending you best wishes,
Sylvie
I got my SIBO after taking augmentin(penicillin) with a probiotic for pelvic Inflammatory disease. I don’t know if it was the penicillin or the probiotic that ruined my intestines but it literally happened overnight. tummy was flat until the moment I had the augmentin/probiotic, then my tummy bloated like crazy and it gave me all these horrible symptoms, and I got a horrible anal fissure from the constipation which took 8 months to heal as mine was methane dominant. I even had a colonoscopy which showed nothing, but that was right after a week of IV clindamycin and gentamicin which I took to cure my pelvic disease since my doctors didn’t want me to take anymore penicillin. The IV antibiotics made my stomach flat and I was happy, but of course, like many others I relapsed.
I am not the only person who got my symptoms after taking penicillin, I’ve talked to a few other people who either got SIBO from penicillin or relapsed on penicillin. This seems strange to me that there are people who got their symptoms from penicillin but I can find no information on it online. Then again it’s hard to find any information regarding SIBO online. To be fair, it could have been that all those antibiotics were altering my gut flora and the probiotic was the culprit but I’m pretty sure it was the penicillin.
I suppose at least I’m lucky enough to know what caused it, but I wanted to warn everybody here about penicillin being a possible cause for SIBO or causing a relapse. Even my doctor agrees that it was the penicillin but of course she’s not sure why. I do know that amoxillin and augmentin can cause many intestinal diseases including colitis and C.diff. so maybe that’s why. I will never be taking penicillin of any kind again unless absolutely necessary.
I’ve taken more penicillin in my life (as a child) than anyone I’ve ever met so, purely anecdotal but it wouldn’t surprise me one bit. Thanks for sharing!