What You Need to Know About the Best Treatment for SIBO

Having a chronic illness like SIBO can be frustrating and challenging. There are a lot of painful symptoms you have to deal with, and treating it is not a one-size-fits-all formula. Luckily, there are treatment options that will help you live well with SIBO and beyond.

In this article, I discuss the three main treatment protocols (antibiotics, herbal antimicrobials and the Elemental Diet) you can undertake to help you manage your symptoms and prevent bacteria from overgrowing.


Best treatments for SIBO

Once you get tested for SIBO, you will be able to identify whether you have hydrogen-dominant SIBO, methane-dominant SIBO or hydrogen sulfide-dominant SIBO, or a mix of all of those gases. From there, your practitioner will recommend a course of treatment based on what SIBO you have and what type of treatment will be most suitable for you.

On average, SIBO patients can expect to reduce their gas levels by approximately 30 parts per million per round of treatment. So if your gas reaches 120 ppm by the 100-minute mark of your SIBO breath test, it may take 4 rounds of treatment (120 / 30 = 4) to clear your SIBO.



Many gastroenterologists and patients often prefer antibiotics because of how they quickly attack bacterial growth.

Rifaximin is the most commonly prescribed antibiotic for SIBO. It’s almost entirely non-absorbable, which means it stays within the small intestine. It is taken for 10-14 days and is used for hydrogen-dominant SIBO or when diarrhoea is the primary symptom.

If methane or constipation is the primary symptom, rifaximin is combined with neomycin or metronidazole. This dual antibiotic therapy is for 10-14 days.

Some SIBO patients can experience intense die-off symptoms while undertaking the antibiotic protocol, so it’s important to discuss this with your practitioner before commencing.

Yeast overgrowth can also increase with ​​neomycin or metronidazole. If you suspect you are also experiencing a fungal overgrowth, it is important to discuss this with your practitioner as you may need to take an antifungal medication at the same time or afterwards.

If you have hydrogen sulfide SIBO, the current recommended antibiotic treatment protocol includes rifaximin, trimethoprim/sulfamethoxazole and amoxicillin-clavulanic.


Herbal antimicrobials

This treatment is often recommended by naturopaths and integrative physicians. Some of the most commonly used herbs include allicin, oregano, berberine and neem.

Compared to antibiotics, herbal antimicrobials take longer to take effect. One round of this treatment is 4 weeks (approximately double the length of time of antibiotics). What’s great about herbal antimicrobials is that they are not only antibacterial, but also antifungal and antiparasitic. These added benefits make them very useful when dealing with more than just a bacterial overgrowth.

Berberine, neem, oregano, cinnamon and uva ursi are used for hydrogen-dominant SIBO. If methane is the dominant gas, allicin is paired with berberine, atrantril, neem or oregano. If you have hydrogen sulfide SIBO, your practitioner will recommend oregano, urva ursi and silver. Note, it is not recommended to take allicin with hydrogen sulfide SIBO due to the sulfur content.

If you’re considering a herbal antimicrobial protocol, speak with your practitioner first. Like all treatments, their application needs to be determined based on your condition and the specific type of SIBO you have.

The Elemental Diet

The Elemental Diet can be an extremely effective treatment option for patients with hydrogen SIBO and/or Intestinal Methanogen Overgrowth(IMO). One study showed 80% of their subjects normalised their SIBO breath test after undertaking the treatment for 14 days.

The Elemental Diet replaces meals with a predigested liquid diet, which seeks to starve the bacteria while providing the individual with amino acids, carbohydrates, fats, vitamins, and minerals. Aside from rapidly reducing gas levels, this treatment also has additional benefits. They include:

  • Giving the digestive system a break and a chance to repair
  • Overweight patients can lose undesired weight that has been gained from having SIBO
  • Underweight patients can gain weight as it provides very simple nutrition
  • Can be a great option when you’re travelling and can’t eat SIBO-friendly food

Although many SIBOers have found success with the Elemental Diet, it’s important to remember that it’s not always 100% effective. There are instances where it can worsen other conditions or food sensitivities. Check in with your practitioner to determine if this is the correct treatment for you.

To learn more, read my blog series about the Elemental Diet here.

Things to keep in mind when treating SIBO

Find the right practitioner
We’re all taking different journeys, so a treatment that worked for others might not work for you. This is why it’s essential to find a practitioner who can help you understand your condition and has the expertise and depth of knowledge required to treat SIBO.

Be clear on your expectations
Some patients only need to do one of the three treatment options to recover from SIBO. However, SIBO is a chronic, recurring condition in two-thirds of all patients. In some cases, multiple rounds are required of one or all three of the available treatments for SIBO.

Address the underlying cause(s)
Your treatment is often just the first step in your total return to health. To truly recover from SIBO, you first need to address the underlying cause(s) of your SIBO to reduce the risk of relapse. This means getting a good understanding of your condition and your body. Learning all the aspects that have led to your compromised gut health will allow you to take the necessary steps to help prevent a SIBO recurrence.

A SIBO diet is not a form of treatment
Instead, it helps control and calm symptoms by reducing the fermentable carbohydrates and fibre the bacteria consume. In fact, most doctors recommend only a maximum of 6 months when following a SIBO diet plan.

Click here to learn more about the different SIBO diet plans.

Re-test for SIBO
Finally, don’t forget to re-test for SIBO after doing a round of treatment, so your practitioner can determine if it was effective for you. Retesting will also help your practitioner identify which gases are still present and in what quantity.

It’s also important to take note of how you are feeling. Listen to your body and see if you feel any improvements. If so, it shows that your body is starting to heal. If not, don’t hesitate to speak to your practitioner, so they can continue to tweak your treatment protocol.


Want to learn more about how you can live well with SIBO and beyond? Sign up for Living Well with SIBO Journey: 5 Week Challenge Program (On-Demand) today. Get instant access to 5 weeks of invaluable SIBO content and expert insights all in one place.

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2 thoughts on “What You Need to Know About the Best Treatment for SIBO”

    1. Hi Frank
      If you look at the 2nd paragraph in the Antibiotic section, you will see I mention Rifaximin. Xifaxin is the brand name of the product which contains the active antibiotic Rifaximin.

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