SIBO and antibiotics

This article gets inspiration from a question of one of our Facebook support groups:

“I don’t understand why we should take antibiotics to treat SIBO when it is precisely taking antibiotics that can lead to it”.

Thank you very much for this relevant question which gives us the opportunity to talk about SIBO and its implementation and management mechanisms.

About SIBO

SIBO corresponds to a bacterial overgrowth in an ectopic site with respect to its physiological location. In the case of SIBO, therefore, there is an “ascent” of the microbiota from the colon to the small intestine. This displacement is accompanied by a change in the composition of the microbiota (=dysbiosis) that can favor different bacterial colonies from one subject to another, hence the distinction between IMO (Intestinal Methanogen Overgrowth) and other types of SIBO.

The repeated and/or prolonged consumption of antimicrobial therapies (antibiotics or antifungals) is one of the main causes of dysbiosis of the intestinal microbiota since, beyond their therapeutic action against the infection to be treated, they have effects (sometimes times significant) on the very composition of the microbiota. Specifically, antibiotics kill bacteria that are susceptible to them just as antifungals decimate yeast colonies. Therefore, the intestinal ecosystem comes to have a reduction in certain colonies of microorganisms and, taking advantage of the “free field” that remains, a proliferation of other opportunistic strains = this is a dysbiosis.

Therefore, it is important to pause here to clarify that nothing in the antimicrobial action of antibiotic and antifungal therapies promotes an increase in the microbiota. These treatments, when they are chronic or “heavy” are exclusively the cause of dysbiosis.

So we come to the bottom line: SIBO is always a multifactorial problem!

This means that, for a SIBO to be established, it is necessary that not one but several risk factors coexist in the subject:

  • risk factors for dysbiosis (including antibiotics, but not the only causes of dysbiosis)
  • risk factors for the rise of the microbiota

Among the most frequent risk factors for the rise of the microbiota are:

PPI use

– hypothyroidism

– sedentary lifestyle

– certain intense or chronic therapies (for example, chemotherapy, antidepressants, etc.)

About SIBO Management

In a patient with SIBO, therefore, we are facing with a multifactorial problem with:

  • reality: bacterial overgrowth in the small intestine
  • a clinical picture that cannot be neglected: signs and symptoms that require rapid and effective treatment (malnutrition, deficiencies, transit disorders, pain, etc.); but that’s just the tip of the iceberg
  • the existence of underlying risk factors that have led to the establishment and chronification of the rise and proliferation of bacteria that must also be taken into account. On this last point, it is necessary to distinguish: the predisposing and precipitating antecedents of SIBO that must be identified and understood + current supporting factors that need to be identified and controlled

In the case of SIBO, therefore, care is provided at several levels:

  • eradication of excess bacterial colonies in the small intestine (and this is why doctors sometimes choose the antibiotic approach to “clean out” the ectopic site of microbiota that shouldn’t be harboring)
  • control of symptoms with palliative measures aimed solely at providing relief and comfort to the patient that allows him to move serenely on his care path (we will mention here the importance of diet – in particular the low FODMAPs diet – and the use of substances to normalize the transit and reduce symptoms)
  • elimination of previously identified risk factors to prevent and prevent relapse*

*As an example:

– reduction or discontinuation of antibiotic and antifungal therapies

– reduction or cessation of PPIs

– normalization of thyroid function

– Increased physical activity

– support and strengthening of the immune system

Therefore, we must insist here on the need to perform ALL LEVELS of care mentioned above to obtain not only rapid and significant relief but also regression of SIBO without the risk of future relapses or recurrences.

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