Therapies & Protocols
SIBO Treatment & Eradication
Compare evidence-based options: prescription antibiotics, herbal antimicrobials, the elemental diet, and the prokinetics and diet changes that help prevent relapse.
Targeted Eradication
Rifaximin, an antibiotic that stays mostly in the gut, and herbal antimicrobials such as berberine, oregano oil and allicin reduce the bacteria in the small intestine.
Biofilms & Motility
Prokinetics such as ginger, low-dose erythromycin or prucalopride support the gut's cleaning waves after treatment. Biofilm disruptors are sometimes added in stubborn cases, with limited evidence.
Elemental Diet & Reset
A liquid formula of pre-digested nutrients is absorbed early in the gut, starving bacteria further down. It normalized breath tests in 80–85% of people in a 2004 study.
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Which treatment, and when?
A quick summary of the evidence for each option. Each guide covers the studies, doses and safety in detail, or see the side-by-side comparison.
| Option | Best evidence | Typically used for |
|---|---|---|
| Prescription antibiotics | Rifaximin cleared SIBO in about 71% across 32 studies; with neomycin, it cleared methane in 87% in one study | Most people; first-line in guidelines |
| Herbal antimicrobials | Herbal blends: 46% negative breath tests vs. 34% on rifaximin in a 2014 records review | People who prefer herbs or did not respond to rifaximin |
| Berberine | Ranked highest in a 2025 network meta-analysis, based on one small trial | Hydrogen SIBO; check drug interactions |
| Elemental diet | 80–85% normalized in a 2004 study; 73% in a 2025 trial | Stubborn cases, or when antibiotics cannot be used |
| Prokinetics & motility | Delayed symptom relapse after successful treatment in a 2009 records review | After treatment, to prevent relapse |
| Prebiotics | PHGG raised rifaximin's clearance rate from 62% to 85% in a 2010 trial | Alongside antibiotics, and to rebuild afterwards |
Treatment Protocols
Clinical Treatment Deep-Dives
