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Role of antibiotics for treatment of inflammatory bowel disease.

Abstract

Inflammatory bowel disease is thought to be caused by an aberrant immune response to gut bacteria in a genetically susceptible host. The gut microbiota plays an important role in the pathogenesis and complications of the two main inflammatory bowel diseases: Crohn's disease (CD) and ulcerative colitis. Alterations in gut microbiota, and specifically reduced intestinal microbial diversity, have been found to be associated with chronic gut inflammation in these disorders. Specific bacterial pathogens, such as virulent Escherichia coli strains, Bacteroides spp, and Mycobacterium avium subspecies paratuberculosis, have been linked to the pathogenesis of inflammatory bowel disease. Antibiotics may influence the course of these diseases by decreasing concentrations of bacteria in the gut lumen and altering the composition of intestinal microbiota. Different antibiotics, including ciprofloxacin, metronidazole, the combination of both, rifaximin, and anti-tuberculous regimens have been evaluated in clinical trials for the treatment of inflammatory bowel disease. For the treatment of active luminal CD, antibiotics may have a modest effect in decreasing disease activity and achieving remission, and are more effective in patients with disease involving the colon. Rifamixin, a non absorbable rifamycin has shown promising results. Treatment of suppurative complications of CD such as abscesses and fistulas, includes drainage and antibiotic therapy, most often ciprofloxacin, metronidazole, or a combination of both. Antibiotics might also play a role in maintenance of remission and prevention of post operative recurrence of CD. Data is more sparse for ulcerative colitis, and mostly consists of small trials evaluating ciprofloxacin, metronidazole and rifaximin. Most trials did not show a benefit for the treatment of active ulcerative colitis with antibiotics, though 2 meta-analyses concluded that antibiotic therapy is associated with a modest improvement in clinical symptoms. Antibiotics show a clinical benefit when used for the treatment of pouchitis. The downsides of antibiotic treatment, especially with recurrent or prolonged courses such as used in inflammatory bowel disease, are significant side effects that often cause intolerance to treatment, Clostridium dificile infection, and increasing antibiotic resistance. More studies are needed to define the exact role of antibiotics in inflammatory bowel diseases.

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  • Authors+Show Affiliations

    ,

    Orna Nitzan, Infectious Disease Unit, Baruch-Padeh Medical Center, Poriya 15208, Israel.

    ,

    Orna Nitzan, Infectious Disease Unit, Baruch-Padeh Medical Center, Poriya 15208, Israel.

    ,

    Orna Nitzan, Infectious Disease Unit, Baruch-Padeh Medical Center, Poriya 15208, Israel.

    Orna Nitzan, Infectious Disease Unit, Baruch-Padeh Medical Center, Poriya 15208, Israel.

    Source

    World journal of gastroenterology 22:3 2016 Jan 21 pg 1078-87

    MeSH

    Animals
    Anti-Bacterial Agents
    Bacteria
    Colitis, Ulcerative
    Crohn Disease
    Gastrointestinal Microbiome
    Host-Pathogen Interactions
    Humans
    Intestines
    Practice Guidelines as Topic
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    26811648

    Citation

    Nitzan, Orna, et al. "Role of Antibiotics for Treatment of Inflammatory Bowel Disease." World Journal of Gastroenterology, vol. 22, no. 3, 2016, pp. 1078-87.
    Nitzan O, Elias M, Peretz A, et al. Role of antibiotics for treatment of inflammatory bowel disease. World J Gastroenterol. 2016;22(3):1078-87.
    Nitzan, O., Elias, M., Peretz, A., & Saliba, W. (2016). Role of antibiotics for treatment of inflammatory bowel disease. World Journal of Gastroenterology, 22(3), pp. 1078-87. doi:10.3748/wjg.v22.i3.1078.
    Nitzan O, et al. Role of Antibiotics for Treatment of Inflammatory Bowel Disease. World J Gastroenterol. 2016 Jan 21;22(3):1078-87. PubMed PMID: 26811648.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Role of antibiotics for treatment of inflammatory bowel disease. AU - Nitzan,Orna, AU - Elias,Mazen, AU - Peretz,Avi, AU - Saliba,Walid, PY - 2015/03/17/received PY - 2015/07/06/revised PY - 2015/11/13/accepted PY - 2016/1/27/entrez PY - 2016/1/27/pubmed PY - 2017/1/18/medline KW - Antibiotic treatment KW - Crohn’s disease KW - Inflammatory bowel disease KW - Ulcerative colitis SP - 1078 EP - 87 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 22 IS - 3 N2 - Inflammatory bowel disease is thought to be caused by an aberrant immune response to gut bacteria in a genetically susceptible host. The gut microbiota plays an important role in the pathogenesis and complications of the two main inflammatory bowel diseases: Crohn's disease (CD) and ulcerative colitis. Alterations in gut microbiota, and specifically reduced intestinal microbial diversity, have been found to be associated with chronic gut inflammation in these disorders. Specific bacterial pathogens, such as virulent Escherichia coli strains, Bacteroides spp, and Mycobacterium avium subspecies paratuberculosis, have been linked to the pathogenesis of inflammatory bowel disease. Antibiotics may influence the course of these diseases by decreasing concentrations of bacteria in the gut lumen and altering the composition of intestinal microbiota. Different antibiotics, including ciprofloxacin, metronidazole, the combination of both, rifaximin, and anti-tuberculous regimens have been evaluated in clinical trials for the treatment of inflammatory bowel disease. For the treatment of active luminal CD, antibiotics may have a modest effect in decreasing disease activity and achieving remission, and are more effective in patients with disease involving the colon. Rifamixin, a non absorbable rifamycin has shown promising results. Treatment of suppurative complications of CD such as abscesses and fistulas, includes drainage and antibiotic therapy, most often ciprofloxacin, metronidazole, or a combination of both. Antibiotics might also play a role in maintenance of remission and prevention of post operative recurrence of CD. Data is more sparse for ulcerative colitis, and mostly consists of small trials evaluating ciprofloxacin, metronidazole and rifaximin. Most trials did not show a benefit for the treatment of active ulcerative colitis with antibiotics, though 2 meta-analyses concluded that antibiotic therapy is associated with a modest improvement in clinical symptoms. Antibiotics show a clinical benefit when used for the treatment of pouchitis. The downsides of antibiotic treatment, especially with recurrent or prolonged courses such as used in inflammatory bowel disease, are significant side effects that often cause intolerance to treatment, Clostridium dificile infection, and increasing antibiotic resistance. More studies are needed to define the exact role of antibiotics in inflammatory bowel diseases. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/26811648/Role_of_antibiotics_for_treatment_of_inflammatory_bowel_disease_ L2 - http://www.wjgnet.com/1007-9327/full/v22/i3/1078.htm DB - PRIME DP - Unbound Medicine ER -