Bacterial Overgrowth Syndrome Medication

Updated: Jul 31, 2018
  • Author: Saqib Zaheer Syed, MBBS; Chief Editor: Michael Stuart Bronze, MD  more...
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Medication

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.

Rifaximin (Xifaxan)

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

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.

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.

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.

Metronidazole (Flagyl)

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

Tetracycline

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

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