Link to full PDF: ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth
M Pimentel et al. Am J Gastroenterol 2020;00:1–14. https://doi.org/10.14309/ ajg.0000000000000501; published online January 8, 2020
One key point is that the authors acknowledge that almost all of their recommendations are based on a very low level of evidence. In fact, only one of their 6 recommendations in Table 1 is considered to have more evidence and it is rated as low level of evidence.
The article provides an in-depth review of small intestinal bacterial overgrowth including underlying homeostasis mechanisms/pathophysiology (Tables 3 & 4) and treatments. For those needing treatment, the authors list options in Table 5 including rifaximin, amoxicillin-clavulanic acid, ciprofloxacin, doxycycline, metronidazole, neomycin, norfloxacin, tetracycline, and trimethoprim-sulfamethoxazole.
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