Letter: pitavastatin supplementation of PEG‐IFN/ribavirin improves sustained virological response against HCV

by Furnari et al., including their recognition of our efforts to summarise the effectiveness of antibiotic therapy for small intestinal bacterial overgrowth (SIBO). We agree that the lack of statistical significance in the meta-analysis of rifaximin vs. placebo is likely due to the small number of included studies and subjects. Their points regarding lactulose vs. glucose breath testing, and the inclusion of patients with coexisting functional and organic gastrointestinal disorders are also well made. The motivation to perform our study was a pragmatic one. Our clinical experience was that many of our patients reported symptoms suggestive of SIBO; yet, the ideal antibiotic regimen remained unclear. As such, we felt that a summary of the evidence for antibiotic therapy in SIBO would be useful to ourselves and to others. Although our study could not identify the ‘ideal’ antibiotic regimen for SIBO, we believe that it does summarise the existing data, and, importantly, highlights the shortcomings of the current literature – which Furnari et al. also nicely summarise. Like Furnari et al. we hope that future studies of SIBO therapy will conform to a more uniform and comparable standard so that management of SIBO can be optimised.