SynthesisFrontiers in pharmacology2026
Antibiotic therapy for small intestinal bacterial overgrowth: a systematic review of comparative efficacy, clinical-test discordance, and pediatric evidence gaps.
Synthesis in Frontiers in pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
4 authors.
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Abstract
Background: Small intestinal bacterial overgrowth (SIBO) and intestinal methanogen overgrowth (IMO) are heterogeneous conditions with poorly standardized antibiotic treatment. This review assessed clinical and test-based outcomes of SIBO therapy, phenotype-specific response, recurrence, and pediatric evidence on the same subject. Methods: PubMed/MEDLINE, Scopus, and Web of Science Core Collection were searched for English-language human studies published between January 2000 and April 2026. Randomized, non-randomized interventional, and observational studies evaluating antibiotic-based treatment for SIBO or methane-positive/IMO phenotypes were included. Owing to substantial heterogeneity, findings were synthesized narratively. Results: Thirty-nine studies were included. Rifaximin was the most frequently studied antibiotic, although outcomes varied considerably. In the only direct three-antibiotic comparison, metronidazole achieved the highest breath-test normalization, whereas rifaximin provided greater improvement in abdominal pain and bloating and fewer adverse events. Rifaximin plus neomycin showed the strongest comparative signal in methane-positive/IMO phenotypes. Clinical and test-based outcomes were frequently discordant, and pediatric evidence remained sparse and inconsistent. Conclusion: No antibiotic was universally superior. In adults, rifaximin appears to offer the most favorable overall balance between symptom improvement and tolerability, whereas metronidazole may achieve higher breath-test normalization in selected patients. Rifaximin plus neomycin showed the strongest comparative signal in methane-positive/IMO phenotypes. Evidence is insufficient to identify a preferred pediatric regimen. Treatment success should integrate symptoms, objective response, tolerability, recurrence, and patient phenotype.
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