Johns-Hopkins Study Compares Efficacy of Herbal and Prescription Antibiotics for SIBO

A negative breath test after treatment was seen in 34% (23/67) of the rifaximin or group vs 46% (17/37) of the herbal treated group (P=.24). Of the 44 rifaximin nonresponders, 57.1% (8/14 ) went on to have a negative breath test after undergoing herbal therapy, and 60% (6/10) went on to obtain a negative breath test with triple antibiotic treatment (P=.89). While there was no significant difference in efficacy between the treatments, the herbal intervention appears as effective as the drug therapies both upfront and in the secondary treatment for rifaximin nonresponders.

Practice Implications

The implications of the study are clear: Herbal treatments are a viable option for patients with SIBO. However, for clinicians, symptom management is as important as the objective measures of the lactulose breath test. Since the study is a retrospective look at the treatments, the objective outcome measure of hydrogen/methane breath made sense. In future studies designed prospectively, symptom relief would be a useful consideration and outcome for clinicians as well.


Chedid V, Dhalla S, Clarke JO, et al. Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Global Adv Health Med. 2014;3(3):16-24.