Do Herbal Supplements and Probiotics Complement Antibiotics and Diet in the Management of SIBO? A Randomized Clinical Trial

Abstract

Small intestinal bacterial overgrowth (SIBO) arises from dysbiosis in the small intestine, manifesting with abdominal symptoms. This study aims to assess the efficacy of combined antibiotic therapy, herbal supplements, probiotics, and dietary modifications in SIBO management. A total of 179 SIBO-diagnosed patients underwent clinical evaluation and breath testing. Patients were categorized into hydrogen (H₂-SIBO) and methane (CH₄-SIBO) groups. The control group received standard antibiotic therapy and a low-FODMAP diet, while the intervention group received additional herbal antibiotics, probiotics, and prebiotics. After treatment, both groups exhibited reduced gas levels, particularly in CH₄-SIBO. Clinical remission rates were higher in the intervention group, especially in CH₄-SIBO cases. Logistic regression analysis showed gas concentrations at diagnosis as significant predictors of treatment success. In conclusion, adjunctive herbal supplements and probiotics did not significantly impact gas levels, but showed potential for clinical improvement, especially in CH₄-SIBO.

Keywords: FODMAP diet; Small Intestine Bacterial Overgrowth (SIBO); antibiotics; dietary supplements; herbal therapies; probiotics.

Figure 1

Diagram of the timeline of patient treatment and follow-up.

Figure 2

Diagnosed probability of normalization after treatment, according to the binary logistic regression model, in relation to the initial concentration of exhaled methane (a) and hydrogen (b). Red: CH₄-SIBO; Blue: H₂-SIBO.