Small Intestinal Bacterial Overgrowth Syndrome

Small intestinal bacterial overgrowth is found in many conditions and may present with malabsorption, diarrhea, and malnutrition. Whereas dietary modifications and supplements might help, the primary treatment strategy is the judicious use of antibiotics. The most effective antibiotics, shown either empirically or by clinical trials, are the quinolones, tetracycline, amoxicillin with clavulanic acid, clindamycin, and metronidazole. In an unpredictable fashion, some patients fail to respond to one of these antibiotics, but often will respond to a second. These conditions are often chronic and require periodic or cyclical treatment. In some conditions seen in the elderly or in hypochlorhydric patients the small intestinal bacterial overgrowth is inconsequential and does not require therapy. Surgical management is reserved for the select situations in which there is a clear-cut structural defect.