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Posted on Fri, 11 Aug 2017 in Digestion and Bowels
Question: My son has Small Intestinal Bacterial Overgrowth. What is the best protocol for getting him over this. He has already done 2 rounds of Rifaximin followed by low dose erythromycin (still on that). The question I just sent is a follow-up question to my original question. We found out he has SIBO. So, will increasing his stomach acid help? How to rid him of the bad bacteria without messing with the good. Are there supposed to be any bacteria in the small intestine?
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Answered by Dr. Ramesh Kumar 51 minutes later
Brief Answer:
Antibiotic therapy is the main stay of treatment.

Detailed Answer:
Hello,
Thanks for query.

Bacterial overgrowth syndrome (BOS) is a term that describes clinical manifestations that occur when the normally low number of bacteria that inhabit the stomach, duodenum, jejunum, and proximal ileum significantly increases or becomes overtaken by other pathogens.


The upper intestinal tract was once thought to be a sterile environment; however, low concentrations of various bacteria are now widely accepted to live within or attached to its luminal surface. These bacteria are thought to be present from the time of birth and through adulthood, living in symbiosis with the human host. This relationship is thought to be vital for normal digestive processes, immunity, and intestinal development.

The four dominant bacterial phyla in the human intestines are Firmicutes, Bacteroidetes, Actinobacteria, and Proteobacteria. Most bacteria belong to the genera Bacteroides, Clostridium, Faecalibacterium, Eubacterium, Ruminococcus, Peptococcus, Peptostreptococcus, and Bifidobacterium.

Even when treating small intestinal bacterial overgrowth with antibiotics, the relapse rate is high. This is a chronic condition that can be cured, but it takes patience, perseverance and a change in diet.

Antibiotics are one of the treatments that are helpful in controlling the excess bacteria.

It is important that not all the bacteria in the intestine are eradicated since some are required to help with normal digestion. Amoxicillin-clavulanate (Augmentin) and Rifaximin (Xifaxan) are the two common first line antibiotics that may be prescribed. While a single course of antibiotics for 1-2 weeks may be sufficient, SIBO has a tendency to relapse, and sometimes repeated courses of antibiotics may be required.

In some people, the antibiotics will be routinely cycled, meaning that they will alternate 1-2 weeks on the antibiotic with 1-2 weeks off.

But we can't just increase stomach acid.

Feel free to ask further.
Thanks.



Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2428 Questions

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