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Antibiotics may benefit patients with small intestinal bacterial overgrowth
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Patients with small intestinal bacterial overgrowth are more likely to experience breath test normalization with antibiotic therapy rather than placebo, according to a recent study.
Researchers performed a systematic review of 10 prospective clinical trials assessing antibiotics for treating small intestinal bacterial overgrowth (SIBO). The studies included comparisons between multiple antibiotics, between antibiotics and placebo, and between different doses of the same antibiotic. The mean sample size was 63 patients, and the primary outcome of the review was normalization of glucose or lactulose breath testing.
Treatment with antibiotics was more effective than placebo, yielding a combined normalization rate of 51.1% across all evaluated regimens, compared with 9.8% among placebo recipients evaluated in four studies.
Rifaximin, reviewed in eight studies, had a pooled rate of breath test normalization ranging from 21.7% at a lower dose (600 mg/day-800 mg/day), 60.8% at a medium dose (1,200 mg/day) and 46.1% at high doses (1,600 mg/day-1,650 mg/day). Metronidazole, evaluated in two studies, had a normalization rate of 51.2%, while ciprofloxacin had a 100% rate in a single study.
Meta-analysis of four studies yielded an OR of 2.55 (95% CI, 1.29-5.04) for the likelihood of breath test normalization with antibiotics compared with placebo, with no significant heterogeneity across studies (P=.32). A second meta-analysis comparing rifaximin and placebo indicated a higher rate of breath test normalization for treated patients (OR=1.97; 95% CI, 0.93-4.17), also without significant heterogeneity (P=.41), but this was not statistically significant.
Justin L. Sewell
“Our systematic review and meta-analysis of the world’s literature reveals relatively few studies of antibiotic therapy for SIBO,” researcher Justin L. Sewell, MD, MPH, assistant clinical professor of medicine in the gastroenterology division at the University of California, San Francisco, told Healio.com. “While antibiotics appear to be superior to placebo for eradicating SIBO, small sample sizes and heterogeneous study designs prevent identification of an ‘ideal’ treatment regimen. The compiled data showing the efficacy of antibiotic therapy for SIBO provides clinicians with an estimate of the likelihood that their patient’s breath test will normalize with different antibiotic options.”
Disclosure: The researchers report no relevant financial disclosures.
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