Run the List SIBO Part III: Treatment
Dec 15, 2025
Dr. Navin Kumar, a gastroenterologist from Brigham and Women's Hospital and co-founder of the podcast, joins Ally Scheve to discuss effective treatment strategies for Small Intestinal Bacterial Overgrowth (SIBO). They delve into the significance of SIBO subtypes—hydrogen vs. methane—and their impact on treatment choices. Navin shares insights on using rifaximin and the complexities of managing methane-predominant cases with dual therapy. He also highlights non-antibiotic solutions like the low FODMAP diet and specific supplements for symptom relief.
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Gas Pattern Determines Treatment
- Always identify whether SIBO is hydrogen- or methane-predominant because gas pattern directs antibiotic choice.
- Breath testing must measure both hydrogen and methane for accurate treatment planning.
First-Line Antibiotic For Hydrogen SIBO
- Use rifaximin 550 mg three times daily for 14 days to treat hydrogen-predominant SIBO.
- Rifaximin is non-absorbed and acts primarily in the gut, so counsel about GI upset and cost concerns.
Alternative Antibiotics When Rifaximin Is Unavailable
- If rifaximin is not covered or affordable, consider alternatives like amoxicillin-clavulanate, metronidazole, ciprofloxacin, or trimethoprim-sulfamethoxazole.
- Discuss comparative efficacy and choose based on safety profile and insurance access.