Meta-analysis: antibiotic therapy for small intestinal bacterial overgrowth.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of clinical trials
PubMed 24004101 · doi:10.1111/apt.12479
What was done
Four databases were searched for clinical trials evaluating antibiotic effectiveness in symptomatic patients with documented small intestinal bacterial overgrowth (SIBO). Studies compared different antibiotics, different doses of the same antibiotic, or antibiotics versus placebo. Study quality and data were extracted independently. The primary outcome was normalization of post-treatment breath testing; the secondary outcome was post-treatment clinical response.
What was found
Ten of 1,356 identified articles met inclusion criteria. Rifaximin was evaluated in 8 studies, yielding a breath test normalization rate of 49.5% (95% CI 44.0–55.1%). Across all evaluated antibiotics, the combined normalization rate was 51.1% (95% CI 46.7–55.5%) compared with 9.8% (95% CI 4.6–17.8%) for placebo. A meta-analysis of 4 placebo-controlled studies favored antibiotics over placebo for breath test normalization (OR 2.55, 95% CI 1.29–5.04). Clinical response was heterogeneously evaluated across 6 studies but tended to correlate with breath test normalization.
Why it matters
This meta-analysis demonstrates that antibiotic therapy, most notably rifaximin, is superior to placebo for normalizing breath tests in SIBO, with test normalization generally tracking clinical symptom improvement.
Limits
The included trials were constrained by modest methodological quality, small sample sizes, and heterogeneous designs. Clinical response was evaluated inconsistently across studies, only 4 trials were eligible for the placebo-controlled meta-analysis, and the total participant count was not reported in the abstract.
Cited by
- supports SIBO is typically treated using an antibiotic protocol.