Counterargument
What if antimicrobials work long term?
Some patients durably resolve recurrent SIBO with antimicrobials alone. The HCM framing of insufficient host capacity does not explain those cases.
Where it is valid
Cases with mild presentations, single antimicrobial cycle, no recurrence over years.
What it challenges
The generality of HCM as a framework for SIBO recurrence.
Host Capacity Model response
HCM is explicitly scoped to the recurrent / treatment-resistant subset. Cases that respond durably to antimicrobials alone are out of scope and not used as evidence for the model.
Unresolved questions
- What proportion of antimicrobial responders maintain remission past 5 years?
- Are durable responders biochemically distinguishable from non-responders at baseline?
Evidence that would resolve this
- Long-term follow-up cohorts of antimicrobial responders with bioenergetic and barrier markers.