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Herbal Therapies vs. Antibiotics for SIBO Management

Small intestinal bacterial overgrowth (SIBO) has become a significant health problem seen in many clinical practices. The prevalence estimates for SIBO in patients with irritable bowel syndrome (IBS) range from 4-78% (higher prevalence in diarrhea-predominant IBS)1 and is thought to be almost as high in many other disorders of the digestive tract. Defined as an increase in the concentration of bacteria of more than 100,000 colony-forming units per mL in the small intestine, SIBO can lead to malabsorption and malnutrition that simulates celiac disease, to milder symptoms similar to IBS – all indicative of a disruption of natural protective mechanisms of the gut. These factors predispose the gut toward dysbiosis.

While most accepted treatment regimens for SIBO include antibiotics, it is also accepted that the response to these regimens are variable and inconsistent. A study from Johns Hopkins Hospital compared the effects of rifaximin (1200 mg/day) to daily, concentrated herbal therapy for 4 weeks in patients with newly diagnosed SIBO.2 The herbal therapy intervention arms included a concentrated berberine formula and concentrated aromatic essential oil formula.

Study results:2

  • Herbal therapies were as effective as rifaximin for resolution of SIBO as measured by lactulose breath testing (LBT)
  • For rifaximin non-responders, the herbal therapies were as effective as triple antibiotic therapy for SIBO rescue therapy
  • Many adverse side effects were reported in the rifaximin treatment arm, while only 1 case of diarrhea was associated with the herbal therapy intervention

In conclusion, the herbal therapies demonstrated equal effectiveness for SIBO resolution as the antibiotics regimen; furthermore, the herbal therapies were associated with significantly fewer, milder side effects.2

View the article

Herbal therapy details are provided in Table 5 of the publication


  1. Ghoshal UC, Srivastava D. Irritable bowel syndrome and small intestinal bacterial overgrowth: meaningful association or unnecessary hype. World J Gastroenterol. 2014;20(10):2482-2491.
  2. Chedid V, Dhalia S, Clarke JO, et al. Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Glob Adv Health Med. 2014;3(3):16-24.

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