ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -12 مورد

Oral antibiotic therapy for small intestinal bacterial overgrowth (SIBO)

Oral antibiotic therapy for small intestinal bacterial overgrowth (SIBO)
Antibiotic Adult dose[1] Pediatric dose*[2,3] Notes
Rifaximin 550 mg 3 times daily

Children and adolescents ≥12 years: Refer to adult dosing

Children 3 to 11 years: 200 mg 3 times daily[4]

Preferred by UpToDate author

Efficacy 61 to 78%

Low systemic absorption

High cost relative to other options
Alternative antibiotics
Trimethoprim-sulfamethoxazole (TMP-SMX) 160/800 mg twice daily 4 to 5 mg/kg of trimethoprim component per dose twice daily[5]  
Ciprofloxacin 500 mg twice daily 10 to 20 mg/kg per dose twice daily Routine use in children avoided due to potential risk of musculoskeletal toxicity (usually mild)
Amoxicillin-clavulanate 875 mg twice daily 25 to 30 mg/kg daily (amoxicillin component) in 2 or 3 divided doses  
Metronidazole 250 mg 3 times daily 10 mg/kg per dose twice daily  
Doxycycline 100 mg once daily to twice daily

Children ≥8 years and >45 kg: Refer to adult dosing

Children <8 years: Not recommended

Less risk of dental staining in children with short course

Use and dosing extrapolated from data with tetracycline
Tetracycline 250 mg 4 times daily

Children ≥8 years: 10 to 15 mg/kg per dose 3 times daily

Children <8 years: Not recommended		 Use in children <8 years old avoided due to risk of permanent tooth discoloration
Suggested antibiotic regimens for reduction of gut flora overgrowth and symptomatic improvement. The author usually treats for 10 days per course with the exception of rifaximin, for which a 14-day course is given. Doses listed are for patients with normal kidney function. For indications and administration of antibiotic therapy in SIBO, refer to the UpToDate clinical topic review.

* Optimal antibiotic regimen(s) in children have not been established. Antimicrobial choices and doses shown are those used by the UpToDate author and some other experts when antibiotic therapy of SIBO is indicated in children[2,3]. The pediatric daily dose should not exceed the usual daily dose for adult patients. Pediatric doses listed in this table are for children ≥6 years except as noted.

¶ In patients with intestinal methane overgrowth (IMO) the author uses a combination regimen of oral rifaximin 550 mg 3 times daily with oral neomycin 500 mg twice daily for 14 days.
References:
  1. Pimentel M, Saad R, Long M, et al. ACG Clinical Guideline: Small intestinal bacterial vergrowth. Am J Gastroenterol 2020; 115:165.
  2. Malik BA, Yuan XY, Wine E, Huynh HQ. Diagnosis and pharmacological management of small intestinal bacterial overgrowth in children with intestinal failure. Can J Gastroenterol 2011; 25:41.
  3. Avelar Rodriguez D, Ryan PM, Ramirez Mayans JA, Quigley EM. Small intestinal bacterial overgrowth in children: A state-of-the-art review. Front Pediatr 2019; 7:363.
  4. Scarpellini E, Giorgio V, Gabrielli M, et al. Rifaximin treatment for small intestinal bacterial overgrowth in children with irritable bowel syndrome. Eur Rev Med Pharmacol Sci 2013; 17:1314.
  5. Kimberlin DW, Brady MT, Jackson MA, Long SS. Dose based on usual range recommended for children. In: Red Book, 31st ed, Committee on Infectious Diseases (Ed); American Academy of Pediatrics 2018.
Graphic 107297 Version 8.0