Dawaa Reference

chronic

Small Intestinal Bacterial Overgrowth (SIBO)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth 2020 · Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph) · Small Intestinal Bacterial Overgrowth - StatPearls - NCBI Bookshelf (NBK546634) - the article states the dose for this indication · Cyanocobalamin DailyMed label, SetID 41ac0dc1-0a71-4c69-8e25-ba838f5f16a3, dosage and administration

Verified against2 documents
  • ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth 2020
  • Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • Bloating, flatulence, and watery diarrhea alongside vague abdominal discomfort are typical [abdominal distension · abdominal pain · diarrhoea · flatulence]
  • Fat malabsorption drives steatorrhea and weight loss, more so with altered gut anatomy [steatorrhoea · weight loss]
  • B12 deficiency from the condition can cause weakness, sensory ataxia, and paresthesia [tingling · unsteadiness]
  • Severe vitamin D deficiency can cause perioral numbness and hand or foot paresthesias from low calcium [numbness]
  • D-lactic acidosis can cause confusion, slurred speech, seizures, and unsteady gait in short bowel or bypass patients [confusion · seizures · slurred speech]

Signs — what you find (2)

  • Exam findings are usually unremarkable outside of significant malnutrition
  • A splashing sound over the abdomen from fluid-filled bowel loops is an uncommon finding

Tests (7)

  • No single test is the accepted gold standard for diagnosing this condition
  • A carbohydrate breath test is positive with a hydrogen rise over 20 parts per million within 90 minutes, or a methane level above 10 parts per million
  • Jejunal aspirate culture supports the diagnosis when bacterial counts exceed 1000 CFU per mL
  • Glucose breath testing sensitivity ranges widely, from 20 to 93 percent, with specificity 45 to 86 percent
  • Lactose breath testing sensitivity and specificity are also wide-ranging, roughly 17 to 68 percent and 44 to 86 percent
  • Upper and lower endoscopy can rule out atrophic gastritis and Crohn disease as alternative causes
  • Magnetic enterography is more sensitive for detecting small bowel strictures but is costly

If not this — what else fits (3)

  • IBS presents with recurrent abdominal pain tied to bowel movements and altered stool frequency or appearance
  • Celiac disease is distinguished by positive celiac serologies together with a negative carbohydrate breath test
  • Crohn disease can show transmural inflammation, granulomas on biopsy, and perianal fissures or fistulas, unlike this condition

SourceStatPearls "Small Intestinal Bacterial Overgrowth" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Second antibiotic given with rifaximin for methane-predominant overgrowth | Replaces the B12 lost to malabsorption

MAIN TREATMENT - choose one

1

RIFAXIMIN

1st line

Strength550 mg

Formoral.solid

Adult dose and duration

550 mg 3 times daily (or 400 mg 3 times daily) x 14 days

Paediatric dose

Specialist pediatric gastroenterology use only

Dose source

ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth 2020

Why

Non-absorbable gastrointestinal-targeted antibiotic with minimal systemic side effects

Cautions
  • Rifaximin is the first-line treatment for hydrogen-predominant SIBO per ACG 2020.
  • Address underlying motility or structural cause to prevent high recurrence rate.
  • Rifaximin is a non-absorbable antibiotic (<0.4% systemic absorption).
Egyptian brands
Egyptian brandManufacturerIndicative price
IDIBACT 550 MG 20 F.C.TAB.INTERNATIONAL DRUG INDUSTRIES > NOVELL PHARMA103.75 EGP (5.19/unit)
ROLAXIMINE 550 MG 30 F.C. TAB.EVA PHARMA > HORUS FOR PHARMACEUTICAL PRODUCTS225.00 EGP (7.50/unit)
RIFAXEROSE 550 MG 10 F.C. TABS.AVERROES PHARMA82.00 EGP (8.20/unit)
BIOREFAMIN 550 MG 10 F.C.TABS.P & C LABS > SOVALUE PHARMA148.00 EGP (14.80/unit)
DUFAXIMIN 550 MG 28 F.C. TABS.AUG PHARMA480.00 EGP (17.14/unit)
FATROXIM 550 MG 30 F.C. TAB.EGPI > ATM PHARMACEUTICAL INDUSTRIES516.00 EGP (17.20/unit)
GASTROBIOTIC 550 MG 30 F.C. TAB.ANDALOUS PHARMA516.00 EGP (17.20/unit)
TRAVIGUARD 550 MG 20 F.C. TABS.P AND C LABS > TREND PHARM344.00 EGP (17.20/unit)
2

METRONIDAZOLE

2nd line

Strength250 mg

Formoral.solid

Adult dose and duration

250 mg 3 times daily x 10-14 days

Paediatric dose

7.5 mg/kg/dose [child max 250 mg]

(7.5 mg/kg 3 times daily for 10-14 days)

Dose by weight
3kg22.5 mg/dose
4kg30 mg/dose
5kg37.5 mg/dose
6kg45 mg/dose
7kg52.5 mg/dose
8kg60 mg/dose
9kg67.5 mg/dose
10kg75 mg/dose
11kg82.5 mg/dose
12kg90 mg/dose
13kg97.5 mg/dose
14kg105 mg/dose
15kg112.5 mg/dose
16kg120 mg/dose
17kg127.5 mg/dose
18kg135 mg/dose
19kg142.5 mg/dose
20kg150 mg/dose
21kg157.5 mg/dose
22kg165 mg/dose
23kg172.5 mg/dose
24kg180 mg/dose
25kg187.5 mg/dose
26kg195 mg/dose
27kg202.5 mg/dose
28kg210 mg/dose
29kg217.5 mg/dose
30kg225 mg/dose
31kg232.5 mg/dose
32kg240 mg/dose
33kg247.5 mg/dose
34kg250 mg/dose (capped)
35kg250 mg/dose (capped)
36kg250 mg/dose (capped)
37kg250 mg/dose (capped)
38kg250 mg/dose (capped)
39kg250 mg/dose (capped)
40kg250 mg/dose (capped)
41kg250 mg/dose (capped)
42kg250 mg/dose (capped)
43kg250 mg/dose (capped)
44kg250 mg/dose (capped)
45kg250 mg/dose (capped)
46kg250 mg/dose (capped)
47kg250 mg/dose (capped)
48kg250 mg/dose (capped)
49kg250 mg/dose (capped)
50kg250 mg/dose (capped)
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph)

Why

Alternative systemic antibiotic option for SIBO when rifaximin is unavailable or cost-prohibitive

Cautions
  • Metronidazole is an alternative for SIBO; it has a higher rate of systemic side effects than rifaximin.
  • Avoid alcohol completely during treatment.
Egyptian brands
Egyptian brandManufacturerIndicative price
TRICHOGYL 250 MG 20 TAB.EL NASR4.35 EGP (0.22/unit)
FLAGICURE 250MG 20 TAB.KAHIRA7.00 EGP (0.35/unit)
TRICHOCID 250MG 20 TAB.CID7.00 EGP (0.35/unit)
METRONIDAZOLE-MUP 250 MG 20 F.C. TABS.MUP11.00 EGP (0.55/unit)
AMRIZOLE 250 MG 20 TABS.AMRIYA20.00 EGP (1.00/unit)
METROZOLE 250MG 20 TAB.MEMPHIS20.00 EGP (1.00/unit)
DUMOZOL 125MG/5ML SUSP. 125ML? strength differs? different route - not oral solidMINA PHARM > ALPHARMA-DENMARK5.75 EGP
METROZOLE 125MG/5ML SUSP. 120 ML? strength differs? different route - not oral solidMEMPHIS19.50 EGP

SECOND ANTIBIOTIC GIVEN WITH RIFAXIMIN FOR METHANE-PREDOMINANT OVERGROWTH - give alongside

3

NEOMYCIN

Second antibiotic given with rifaximin for methane-predominant overgrowth

add-on - not a substitute

Strength500 mg

Formoral.solid

Adult dose and duration

1000 mg a day by mouth, alongside rifaximin x 2 weeks

Paediatric dose

No paediatric dose for this indication in the sources opened; the formulary's paediatric neomycin doses are for hepatic encephalopathy and bowel preparation.

Dose source

Small Intestinal Bacterial Overgrowth - StatPearls - NCBI Bookshelf (NBK546634) - the article states the dose for this indication

Why

The card treats every SIBO the same way. Methane-predominant overgrowth responds poorly to rifaximin alone, and the article gives a specific two-drug regimen for it.

Cautions
  • It is an adjunct to rifaximin for the methane-predominant type, not a treatment on its own.
  • Do not exceed two weeks; a little is absorbed and prolonged use risks deafness and kidney damage.
  • Contraindicated in intestinal obstruction and in inflammatory or ulcerative bowel disease.
  • Reduce or stop it if the kidney function falls, and avoid it in anyone who has reacted badly to another aminoglycoside.
Egyptian brands
Egyptian brandManufacturerIndicative price
NEOMYCIN 500 MG 20 TAB.MEMPHIS19.00 EGP (0.95/unit)

REPLACES THE B12 LOST TO MALABSORPTION - give alongside

4

CYANOCOBALAMIN

Replaces the B12 lost to malabsorption

add-on - not a substitute

Forminjection

Adult dose and duration

100 mcg by intramuscular or deep subcutaneous injection daily for six or seven days; the label then lengthens the interval step by step before settling at 100 mcg monthly for life

Paediatric dose

No paediatric dose in the sources opened.

Dose source

Cyanocobalamin DailyMed label, SetID 41ac0dc1-0a71-4c69-8e25-ba838f5f16a3, dosage and administration - verbatim: "A dose of 100 mcg daily for six or seven days should be administered by intramuscular or deep subcutaneous injection."

Why

Low B12 with macrocytic anaemia is the classic laboratory picture of SIBO and it causes real neurological harm. Because the problem is malabsorption, the injection is the route that works.

Cautions
  • Give it intramuscularly or deep subcutaneously, never intravenously - almost all of an intravenous dose is lost in the urine.
  • Contraindicated in anyone sensitive to cobalt or to vitamin B12 itself.
  • Confirm the deficiency before treating, and correct the overgrowth as well, or it will come straight back.
Egyptian brands
Egyptian brandManufacturerIndicative price
CIDOLVEX 1MG/ML I.M AMP.CID5.20 EGP
BETO-12 1MG/ML 2 AMP.AMOUN11.00 EGP
RUBIVAMIN 1000 MCG 5 AMPS.MISR42.50 EGP
BETOLVEX 1MG/ML 2 AMPS. I.M.MINA PHARM64.00 EGP
BETOLVEX 1MG/ML 2 PRE-FILLED SYRINGE I.M.MINA PHARM110.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.