{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T08:07:26Z","timestamp":1789027646355,"version":"build-2803163510"},"reference-count":102,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Small intestinal bacterial overgrowth (SIBO) and intestinal methanogen overgrowth (IMO) are heterogeneous conditions with poorly standardized antibiotic treatment. This review assessed clinical and test-based outcomes of SIBO therapy, phenotype-specific response, recurrence, and pediatric evidence on the same subject.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed\/MEDLINE, Scopus, and Web of Science Core Collection were searched for English-language human studies published between January 2000 and April 2026. Randomized, non-randomized interventional, and observational studies evaluating antibiotic-based treatment for SIBO or methane-positive\/IMO phenotypes were included. Owing to substantial heterogeneity, findings were synthesized narratively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty-nine studies were included. Rifaximin was the most frequently studied antibiotic, although outcomes varied considerably. In the only direct three-antibiotic comparison, metronidazole achieved the highest breath-test normalization, whereas rifaximin provided greater improvement in abdominal pain and bloating and fewer adverse events. Rifaximin plus neomycin showed the strongest comparative signal in methane-positive\/IMO phenotypes. Clinical and test-based outcomes were frequently discordant, and pediatric evidence remained sparse and inconsistent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>No antibiotic was universally superior. In adults, rifaximin appears to offer the most favorable overall balance between symptom improvement and tolerability, whereas metronidazole may achieve higher breath-test normalization in selected patients. Rifaximin plus neomycin showed the strongest comparative signal in methane-positive\/IMO phenotypes. Evidence is insufficient to identify a preferred pediatric regimen. Treatment success should integrate symptoms, objective response, tolerability, recurrence, and patient phenotype.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1908516","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T07:21:40Z","timestamp":1789024900000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Antibiotic therapy for small intestinal bacterial overgrowth: a systematic review of comparative efficacy, clinical\u2013test discordance, and pediatric evidence gaps"],"prefix":"10.3389","volume":"17","author":[{"given":"Ana Maria","family":"Koller","sequence":"first","affiliation":[{"name":"Doctoral School of Medicine and Pharmacy, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u015f","place":["Targu Mures, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Oana","family":"S\u0103s\u0103ran","sequence":"additional","affiliation":[{"name":"Department of Pediatrics 3, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219","place":["Targu Mures, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ancu\u021ba","family":"Lupu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy","place":["Ia\u015fi, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Oana","family":"M\u0103rginean","sequence":"additional","affiliation":[{"name":"Department of Pediatrics 1, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219","place":["Targu Mures, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e60042","DOI":"10.1371\/journal.pone.0060042","article-title":"Modulation of the metabiome by rifaximin in patients with cirrhosis and minimal hepatic encephalopathy","volume":"8","author":"Bajaj","year":"2013","journal-title":"PLoS ONE"},{"key":"B2","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1111\/j.1365-2036.2009.04018.x","article-title":"Comparison of the prevalence of fructose and lactose malabsorption across chronic intestinal disorders","volume":"30","author":"Barrett","year":"2009","journal-title":"Aliment. 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