Small Intestinal Bacterial Overgrowth: A Review of Current Antibiotic Strategies and Emerging Alternatives

Small intestinal bacterial overgrowth, a common gastrointestinal condition, remains largely undiagnosed. The treatment of choice is antibiotic therapy, with rifaximin being the most popular. Studies show a high recurrence rate after initial treatment, indicating the necessity for alternative treatment options. This narrative review provides a general description of the condition with the associated pathophysiology, clinical presentation, diagnosis, imaging, the role of older antibiotics, and contemporary interventions. Furthermore, it emphasizes the evidence of emerging treatments such as herbal medicine, probiotics, faecal microbiota transplantation (FMT), and other dietary modifications. It also emphasizes novel strategies, such as engineered probiotics and phage therapy.