Small bacterial overgrowth in children
|Next review: 01/07/2024|
|Approved By: IAPG|
|Copyright© Leeds Teaching Hospitals NHS Trust 2021|
This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
TREATMENT OF SMALL INTESTINAL BACTERIAL OVERGROWTH (SIBO) IN CHILDREN
There are no specific tests are currently available in LTHT for diagnosing Small Intestinal Bacterial Overgrowth (SIBO). Treatment should be initiated if there is strong clinical suggestion of SIBO based on symptoms and risk factors.
The underlying cause of the bacterial overgrowth should be treated where possible. Ancillary treatments are listed below which may be considered based upon the cause of the bacterial overgrowth:
- Diet - high fat, low carbohydrate
- Prokinetics for dysmotility
- Surgery for abnormalities of the GI tract
- Treatment of nutritional deficits - notably calcium, magnesium, iron and vitamins
- Stop gastric acid suppressor medication
Treatment should be only initiated by a Consultant Paediatric Gastroenterologist or Consultant Paediatric gastrointestinal surgeon.
|Empirical options for SIBO|
Duration: Treatment is to be prescribed as a cyclical course with 2 weeks on and 2 weeks off treatment. Treatment should continue as long as it is effective (e.g. decreased abdominal pain/bloating, reduced flatulence/diarrhoea) but needs regular reviews by the clinical team1.
If SIBO remains most likely/confirmed diagnosis regimen should be decided after discussion with Consultant Gastroenterologist or Microbiologist.
- The course can also be given as 1 week on and 1 week off and, for the most difficult cases, Rifaximin can be given continuously. This can be considered if the patient starts to develop symptoms of bacterial overgrowth 5-8 days after stopping antibiotic for week off.
- Specialist input = Consultant Paediatric Gastroenterologist
Small bacterial overgrowth (SIBO)
|Target patient group:||Children|
|Target professional group(s):||Pharmacists
Secondary Care Nurses
- Arasaradnam RP, Brown S, Forbes A et al. 2018. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition Gut;0:1–20.
- Avelar Rodriguez D et al. 2019. Small Intestinal Bacterial Overgrowth in Children: A State-Of-The-Art Review. Front Pediatr; 7:363.
- Dulkowicz, A.C., Lacy, B.E. and Levine, G.M. 2007. Small Intestinal Bacterial Overgrowth: A Comprehensive Review. Gastroenterology & Hepatology Volume 3, Issue 2: 112-123. Evidence level A.
- Gatta L, Scarpignato C. 2017. Systematic review with meta-analysis: rifaximin is effective and safe for the treatment of small intestine bacterial overgrowth. Aliment Pharmacol Ther; 45(5):604-616. doi:10.1111/apt.13928
- Grace E, Shaw C, Whelan K et al. 2013. Review article: small intestinal bacterial overgrowth – prevalence, clinical features, current and developing diagnostic tests, and treatment. Aliment Pharmacol Ther; 38: 674-688
- Khalighi et al. 2014. Evaluating the efficacy of probiotic on treatment in patients with small intestinal bacterial overgrowth (SIBO) - A pilot study. Indian J Med Res; 140(5): 604–608.
- Lauritano EC, Gabrielli M, Scarpellini E, et al. 2008. Small intestinal bacterial overgrowth recurrence after antibiotic therapy. Am J Gastroenterol; 103:2031.
- Malik BA et al. 2011. Diagnosis and pharmacological management of small intestinal bacterial overgrowth in children with intestinal failure. Can J Gastroenterol; 25(1): 41-45.
- Planas-Vilaseca, A. et al. 2016. D-lactic acidosis: A rare cause of metabolic acidosis. Endocrinología, Diabetes y Nutrición (English ed.). Vol: 63(8): 433-434
- Quigley EM & Quera R. 2006. Small intestinal bacterial overgrowth: roles of antibiotics, prebiotics, and probiotics. Gastroenterology; 130 :78–90.
- Reddy VS, Patole SK and Rao S. 2013. Role of Probiotics in Short Bowel Syndrome in Infants and Children—A Systematic Review. Nutrients; 5: 679-99
- Rosania R et al. 2013. Effect of probiotic or prebiotic supplementation on antibiotic therapy in the small intestinal bacterial overgrowth: a comparative evaluation. Curr Clin Pharmacol; 8(2):169-72.
- Shah SC, Day LW, Somsouk M, Sewell JL. 2013. Meta-analysis: Antibiotic therapy for small intestinal bacterial overgrowth. Aliment Pharmacol Ther; 38:925–34.
LHP version 1.0
Equity and Diversity
The Leeds Teaching Hospitals NHS Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group.