Bacterial Overgrowth Syndrome Medication

  • Author: Saqib Zaheer Syed, MBBS; Chief Editor: Michael Stuart Bronze, MD   more...
 
Updated: Apr 11, 2011
 

Medication Summary

The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications.

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Antibiotics

Class Summary

Therapy should be directed against B fragilis.

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Rifaximin (Xifaxan)

 

Antibiotic of choice as clinical resistance may be less frequent than with other antibiotics.

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Amoxicillin-clavulanic acid (Augmentin)

 

First-line antibiotic for bacterial overgrowth syndrome due to anatomic abnormalities and diabetes and for elderly patients with idiopathic bacterial overgrowth syndrome. Provides good gram-negative, gram-positive, and anaerobic coverage. Reduces number of bacteria in small bowel lumen.

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Clindamycin (Cleocin)

 

Works well in elderly patients with idiopathic bacterial overgrowth syndrome, especially if bile malabsorption coexists. Good anaerobic and gram-positive coverage, except enterococci.

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Gentamicin

 

Useful in neonates and infants with idiopathic bacterial overgrowth syndrome. Aminoglycoside that provides excellent aerobic gram-negative coverage in bowel when administered PO.

Not well absorbed PO. Studies have not established serum levels with enteral administration and compromise of intestinal lumen.

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Metronidazole (Flagyl)

 

First-line antibiotic for elderly patients with idiopathic bacterial overgrowth syndrome. Provides good anaerobic coverage.

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Tetracycline

 

Effective for patients with bacterial overgrowth syndrome. Provides anaerobic coverage.

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Contributor Information and Disclosures
Author

Saqib Zaheer Syed, MBBS  Resident Physician, Department of Internal Medicine, University of Oklahoma Health Science Center

Disclosure: Nothing to disclose.

Coauthor(s)

Michael Stuart Bronze, MD  Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark R Wallace, MD, FACP, FIDSA  Clinical Professor of Medicine, Florida State University College of Medicine; Head of Infectious Disease Fellowship Program, Orlando Regional Medical Center

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Joseph F John Jr, MD, FACP, FIDSA, FSHEA  Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD  Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

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