Bacterial Overgrowth Syndrome Medication

Updated: Jun 11, 2020
  • Author: Chinelo N Animalu, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce the burden of microorganisms in the intestine rather than achieve complete eradication, 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.

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.

Trimethoprim/sulfamethoxazole (Bactrim, Bactrim DS, Cotrim)

Trimethoprim-sulfamethoxazole can be used as alternative antibiotics in both pediatric and adult patients with bacterial overgrowth syndrome. The dose should be adjusted in patients with renal impairment. Sulfamethoxazole and trimethoprim cross the placenta and should be avoided in pregnant women to prevent increased risk of congenital malformations.

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Sulfonamide Derivative

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