Am J Gastroenterol 2011
Antibiotic therapy may induce remission in active ulcerative colitis and Crohn's disease, giving weight to the notion that inflammatory bowel disease (IBD) is of bacterial origin.
But the researchers who drew this conclusion also said the data they pooled for a meta-analysis were difficult to interpret.
Dr. Paul Moayyedi of McMaster University Medical Center, Hamilton, Ontario, Canada and colleagues note that while gut flora might play an important role in the pathogenesis of IBD, therapy has focused on suppressing the immune system rather than on use of antibiotics. Moreover, when antibiotics have been used, results were conflicting.
In 10 randomized trials involving 1160 Crohn's disease patients, antibiotics were effective in reducing the relative risk of active disease not in remission to 0.85 compared to placebo. A diverse variety of antibiotics were employed, including macrolides, fluoroquinolones, 5-nitroimidazoles, and rifaximin alone and in combination.
In particular, rifamycin derivatives either alone or in combination with other antibiotics appeared to have a significant effect at inducing remission in active Crohn's disease, the researchers said in a March 15th online paper in The American Journal of Gastroenterology.
There also were favorable findings in 123 patients with perianal Crohn's disease fistula who used either ciprofloxacin or metronidazole. Antibiotic therapy also appeared to reduced relapse in 186 patients with quiescent disease.
In nine randomized controlled trials involving 662 patients with ulcerative colitis, antibiotics were significantly more likely to induce remission.
The team cautions that the trend to overall benefit seen with antibiotics might be due to bias. Still, they think further research into the use of antibiotics is a priority.
"Ideally, individual antibiotics should be evaluated separately and together in a factorial design to establish whether different classes of antibiotics have a synergistic action in treating IBD," they conclude.
Antibiotic therapy may induce remission in active ulcerative colitis and Crohn's disease, giving weight to the notion that inflammatory bowel disease (IBD) is of bacterial origin.
But the researchers who drew this conclusion also said the data they pooled for a meta-analysis were difficult to interpret.
Dr. Paul Moayyedi of McMaster University Medical Center, Hamilton, Ontario, Canada and colleagues note that while gut flora might play an important role in the pathogenesis of IBD, therapy has focused on suppressing the immune system rather than on use of antibiotics. Moreover, when antibiotics have been used, results were conflicting.
In 10 randomized trials involving 1160 Crohn's disease patients, antibiotics were effective in reducing the relative risk of active disease not in remission to 0.85 compared to placebo. A diverse variety of antibiotics were employed, including macrolides, fluoroquinolones, 5-nitroimidazoles, and rifaximin alone and in combination.
In particular, rifamycin derivatives either alone or in combination with other antibiotics appeared to have a significant effect at inducing remission in active Crohn's disease, the researchers said in a March 15th online paper in The American Journal of Gastroenterology.
There also were favorable findings in 123 patients with perianal Crohn's disease fistula who used either ciprofloxacin or metronidazole. Antibiotic therapy also appeared to reduced relapse in 186 patients with quiescent disease.
In nine randomized controlled trials involving 662 patients with ulcerative colitis, antibiotics were significantly more likely to induce remission.
The team cautions that the trend to overall benefit seen with antibiotics might be due to bias. Still, they think further research into the use of antibiotics is a priority.
"Ideally, individual antibiotics should be evaluated separately and together in a factorial design to establish whether different classes of antibiotics have a synergistic action in treating IBD," they conclude.
