of such treatment in sibo. a course of one week of antibiotics is usually sufficient to treat the condition. however, if the condition recurs, antibiotics can be given in a cyclical fashion in order to prevent tolerance. for example, antibiotics may be given for a week, followed by three weeks off antibiotics, followed by another week of treatment. alternatively, the choice of antibiotic used can be cycled. there is still limited data to guide the clinician in developing antibiotic strategies for sibo. therapy remains, for the most part, empiric. however, concerns exist about the potential risks of long-term broad-spectrum antibiotic therapy. probiotics are bacterial preparations that alter the bacterial flora in the bowel to cause a beneficial effect. animal research has demonstrated that probiotics have barrier enhancing, antibacterial, immune modulating and anti-inflammatory effects which may have a positive effect in the management of sibo in humans. lactobacillus casei has been found to be effective in improving breath hydrogen scores after 6 weeks of treatment presumably by suppressing levels of a small intestinal bacterial overgrowth of fermenting bacteria. the multi-strain preparation vsl#3 was found to be effective in suppressing sibo. lactobacillus plantarum, lactobacillus acidophilus, and lactobacillus casei have all demonstrated effectiveness in the treatment and management of sibo. conversely, lactobacillus fermentum and saccharomyces boulardii have been found to be ineffective. a combination of lactobacillus plantarum and lactobacillus rhamnosus has been found to be effective in suppressing bacterial overgrowth of abnormal gas producing organisms in the small intestine. probiotics are superior to antibiotics in the treatment of sibo. a combination of probiotic strains has been found to produce better results than therapy with the antibiotic drug metronidazole. an elemental diet has been shown to be highly effective for eliminating sibo with a two-week diet demonstrating 80% efficacy and a three-week diet demonstrating 85% efficacy. an elemental diet works via providing nutrition for the individual while depriving the bacteria of a food source. additional treatment options include the use of prokinetic drugs such as 5-ht4 receptor agonists or motilin agonists to extend the sibo free period after treatment with an elemental diet or antibiotics. a diet void of certain foods that feed the bacteria can help alleviate the symptoms. for example, if the symptoms are caused by bacterial overgrowth feeding on indigestible carbohydrate rich foods, following a fodmap restriction diet may help.