Bowl of medications sitting on a countetop with some of the medications scattered on the counter

Effective Treatment for SIBO According to SIBO Type

To understand the treatment options for SIBO, we need to first make sure we understand what SIBO is and what it is not. Because let’s face it, there’s a lot of false information flying around in internet land!

Small intestinal bacterial overgrowth, or SIBO, is a relatively common condition among those with IBS. The condition itself occurs when bacteria start to populate the small intestine and then the balance of bacteria gets out of whack.

When this occurs, some types of bacteria grow too large in numbers forcing others to become too small in numbers. This disrupts the harmony between them and causes symptoms of gas, bloating, either constipation or diarrhea (sometimes both), bowel urgency, abdominal pain, etc.

For more on the basics of SIBO, see my post “What is SIBO” as well as my post on the different “Types of SIBO”. We will build on the information in these other posts so it may be helpful for you to read them first.

There are three main treatments for SIBO – pharmaceutical antibiotics, herbal antibiotics and the elemental diet. We will discuss each one.

Pharmaceutical Antibiotics

This is possibly the most, or one of the most, common treatments of the three. Here is where my post “Types of SIBO” comes in handy to have a good grasp on. The reason being, each type of SIBO requires a different treatment when it comes to pharmaceutical and herbal antibiotics.

A woman pouring some pills from a prescription bottle into her hand.

Rifaximin is the most common antibiotic for SIBO. Usually, for hydrogen SIBO, this is the only medication needed for treatment.

For methane sibo, or IMO, a combination of rifaximin and neomycin is often used. Patients usually take these at the same time for best efficacy.

According to researcher, Dr. Mark Pimentel with Cedars Sinai Medical Center, only about 20% of patients with methane SIBO/IMO had improvement after using rifaximin alone. The success rate was much higher with a combination of both medications. Remember, different types of SIBO result from different types of microorganisms so the antibiotics/medications used to treat them will be different.

Often, the treatment for hydrogen sulfide SIBO, is rifaximin plus bismuth. This is the newest type of SIBO so treatment research for it is also relatively new. At time of this writing however, this is the recommendation for best treatment.

Herbal Antibiotics

Most often, herbal therapy consists of a combination of several different herbs. Common ones include oregano, allicin (if methane SIBO is present), berberine (if hydrogen sibo is present) and neem.

There are some formulations that contain several of these herbs, and sometimes a few others, present in one herbal blend. Other times patients will take some of these herbs in separate forms but in combination with eachother.

A variety of herbal pills sitting on a table next to a spice crusher bowl with a fresh sprig of herbs coming out of it.

Though herbal therapies are available over the counter, it is important to use them under the guidance of a trained health practitioner. They will be able to help you choose which herbs to use based on your type of SIBO, as well as guide you on frequency, amount, duration, etc. in order to treat your SIBO safely and effectively.

Elemental Diet

The elemental diet is liquid nutrition that replaced solid food for two, sometimes three weeks. The word “elemental” means in its simplest form.

Our body needs to break down carbohydrates, fats and proteins in order to absorb them. Elemental diet solutions contain these broken down particles, as well as any other essential vitamins and minerals that we need.

Since it is already in it’s simplest form, our GI tract absorbs it right away BEFORE it gets to the bacteria. The idea is that by drinking only the elemental diet for several weeks, it will starve out the bacterial overgrowth.

A woman sitting on the floor in a sweat suit drinking out of a glass


All of these treatments have proven to be effective for treating SIBO/IMO. Again, if you suspect SIBO, it is important that you take a breath test for it (more information in my post “Types of SIBO”). That way, you know which type you have and you can pursue the best treatment possible!

Thanks for reading!