What to Know Before & After SIBO Treatment

Last updated: July 2020

Currently, the gold standard for the treatment of SIBO is a doctor-prescribed antibiotic. But how do you navigate questions around antibiotic use? What should you be asking your doctor? Are probiotics safe to take? And what is safe to eat during treatment? What diet should be followed during antibiotic usage?

It is important to understand the commonly asked questions about antibiotic treatment and diet for SIBO—having a “cheat sheet” of sorts for you to advocate as a patient is vital for your care and health. Knowing what SIBO antibiotic medications are typically prescribed and reviewed in the literature can help you navigate the right questions to ask your doctor. You can use the insights to guide your treatment with a doctor, including the basis for an antibiotic selection, side effects, reoccurrence, and diet implications.

Speaking with your doctor

Unfortunately, in my clinical experience, most patients are given very little information about the antibiotic they are prescribed, and why and what diet to follow, etc. It can be very frustrating, but let’s be very clear: The blame doesn’t fall on the physician, rather our medical system, as a whole instead. The way our current system is set up is the average time allotted per medical visit is only around 20 minutes. So much has to be uncovered and discussed in such a short amount of time. It’s far from an ideal system to obtain the quality of healthcare you need. The odds are stacked against you.

For that reason, you have to be prepared, strategic, and efficient. Understanding and documenting your symptoms, and having your questions ready will help you maximize your time, and improve your care.

Consider asking why you developed SIBO in the first place. Is there any underlying condition or risk factor that needs to be treated as well?

The hydrogen breath test

Were you tested with a hydrogen breath test? If so, consider asking what the results showed. Were they very positive? Slightly positive? Negative? Ask your doctor or the nurse practitioner to briefly explain the hydrogen breath test.

“Hydrogen breath tests are widely used to explore pathophysiology of functional gastrointestinal (GI) disorders. Small intestinal bacterial overgrowth (SIBO) and carbohydrate malabsorption are disorders detected by these tests that have been proposed to be of great importance for symptoms of GI diseases.”1

Antibiotics and SIBO

Ask your doctor about the medication they’ve prescribed for you. Providers often prescribe antibiotics to treat SIBO. The antibiotics most often prescribed are Rifaximin for H2-positive SIBO and neomycin. Treatment should depend on whether hydrogen or methane gas was elevated.

Questions to ask

  • What kind of antibiotic was prescribed, and why?
  • What kind of dosage and how long will you need to take it? Typically, this is based on the magnitude they perceive your overgrowth to be, which you may want to know.
  • Do they know of any common side effects? Remember, side effects can be uncomfortable, but they’re temporary. But it’s important to know and discuss with your doctor in case you forget a condition you have that could be exacerbated by the antibiotic.

Tips on the cost of antibiotics and SIBO

  • Inquire about the cost of the antibiotics before it is prescribed.
  • Ask your insurance company if it is covered.
  • If not covered, can you self-finance this? If not, it could be worth discussing if there are any options with your doctor.

Diet and SIBO

Can you handle high FODMAP foods or foods that previously were triggering? You should be able to tolerate any foods that felt fine to you pre-SIBO. Ask for a referral to see a registered dietitian, ask if they regularly work with IBS and SIBO patients. If elemental diets are recommended, there is no solid evidence for this. The evidence for herbal remedies as treatment is weak.

Still not feeling better after SIBO treatment?

If you don’t feel completely better, discuss with your doctor possible options for a different antibiotic or underlying causes of SIBO.

For additional tips on how to come exceptionally prepared to discuss your SIBO treatment with your doctor, I find the book, "Bloated Belly Whisperer" by Tamara Duker Freuman, MS, RD, CDN, very helpful for my patients.

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