NEW YORK (Reuters Health) Mar 18 - Adding a 2-week course of triple antibiotic therapy to existing medications helps induce and maintain remission of ulcerative colitis (UC), according to a report from Japan.
In the March 9th online issue of The American Journal of Gastroenterology, the authors cite reports that Fusobacterium varium may trigger ulcerative colitis flares. This evidence led Dr. Toshifumi Ohkusa and colleagues to test an antibiotic mix with known efficacy against the microbe.
They randomized 210 patients with chronic relapsing ulcerative colitis to receive oral antibiotics (amoxicillin 1500 mg/d, tetracycline 1500 mg/d, and metronidazole 750 mg/d) or placebo for 2 weeks. All patients continued to take any other oral or rectal medications as before, except that corticosteroid tapering started at 8 weeks.
Roughly 60% of patients in each group had moderate or severe disease; close to half in both groups had extensive colon involvement, and slightly more than half were taking steroids.
The main study endpoint was clinical response, determined by endoscopic findings at 3 months after treatment completion.
Endoscopic scores were significantly improved at 3 months and 12 months in the treatment group.
The response rate with antibiotics was nearly double that seen with placebo: 44.8% vs. 22.8% (p = 0.001). At 3 months, the remission rates with antibiotics and placebo were comparable (19.0% vs. 15.8%, respectively), but by 12 months, the antibiotics group had a significantly higher rate: 26.7% vs. 14.9% (p = 0.041).
All of the clinical effects were greater in patients with Mayo scores of 6 to 12, indicating active disease, Dr. Ohkusa, from Kashiwa Hospital, and colleagues report.
F. varium antibody levels fell in antibiotic responders, but not in nonresponders, nor in placebo patients.
Among patients who were steroid-dependent at baseline, 34.7% in the antibiotics group were steroid-free (for at least 3 months) at 12 months, compared with just 13.7% from the placebo group (p = 0.019).
The antibiotics were generally well tolerated, with no serious drug-related toxicities, the report indicates.
The authors conclude, "We propose (this antibiotic regimen) to be considered alongside conventional therapy in patients with relapsing ulcerative colitis as an alternative to undertaking surgery."
Am J Gastroenterol 2010.
In the March 9th online issue of The American Journal of Gastroenterology, the authors cite reports that Fusobacterium varium may trigger ulcerative colitis flares. This evidence led Dr. Toshifumi Ohkusa and colleagues to test an antibiotic mix with known efficacy against the microbe.
They randomized 210 patients with chronic relapsing ulcerative colitis to receive oral antibiotics (amoxicillin 1500 mg/d, tetracycline 1500 mg/d, and metronidazole 750 mg/d) or placebo for 2 weeks. All patients continued to take any other oral or rectal medications as before, except that corticosteroid tapering started at 8 weeks.
Roughly 60% of patients in each group had moderate or severe disease; close to half in both groups had extensive colon involvement, and slightly more than half were taking steroids.
The main study endpoint was clinical response, determined by endoscopic findings at 3 months after treatment completion.
Endoscopic scores were significantly improved at 3 months and 12 months in the treatment group.
The response rate with antibiotics was nearly double that seen with placebo: 44.8% vs. 22.8% (p = 0.001). At 3 months, the remission rates with antibiotics and placebo were comparable (19.0% vs. 15.8%, respectively), but by 12 months, the antibiotics group had a significantly higher rate: 26.7% vs. 14.9% (p = 0.041).
All of the clinical effects were greater in patients with Mayo scores of 6 to 12, indicating active disease, Dr. Ohkusa, from Kashiwa Hospital, and colleagues report.
F. varium antibody levels fell in antibiotic responders, but not in nonresponders, nor in placebo patients.
Among patients who were steroid-dependent at baseline, 34.7% in the antibiotics group were steroid-free (for at least 3 months) at 12 months, compared with just 13.7% from the placebo group (p = 0.019).
The antibiotics were generally well tolerated, with no serious drug-related toxicities, the report indicates.
The authors conclude, "We propose (this antibiotic regimen) to be considered alongside conventional therapy in patients with relapsing ulcerative colitis as an alternative to undertaking surgery."
Am J Gastroenterol 2010.