Treatment options for small intestinal bacterial overgrowth

The best therapeutic approach for patients with small bowel bacterial overgrowth is a combination of the removal of all predisposing conditions and the administration of broad-spectrum antibiotics. In the case of non-modifiable predisposing factors, patients with bacterial overgrowth need a strict follow-up after successful decontamination with antibiotics, in order to promptly assess and treat disease recurrence. Up to now, the choice of antibiotics has been primarily empiric because of the presence of several different bacterial species in the contaminating flora and the impossibility of applying in vitro susceptibility tests. Several systemic and non-absorbable antibiotic agents have been shown to be effective for decontamination of small bowel bacterial overgrowth. The best antibiotic scheme in terms of drug, dosage and duration of therapy remains, however, to be assessed. The non-absorbable agents seem to be associated with better safety and tolerability than systemic drugs. In the present paper, all available therapeutic approaches to small bowel bacterial overgrowth are reviewed.