Dan Turner1, Arie Levine2, Kaija-Leena Kolho3, Ron Shaoul4, Oren Ledder5. 1. The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel. Electronic address: turnerd@szmc.org.il. 2. Wolfson Medical Center, Holon, Israel. 3. Pediatric Gastroenterology, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland. 4. Pediatric Gastroenterology Unit, Rambam Medical Center, Haifa, Israel. 5. The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel.
Abstract
BACKGROUND: The results of previous studies on the effectiveness of antibiotics in ulcerative colitis (UC) seem more effective when used orally. In this retrospective, multicenter study, we aimed to report our experience of using a combination of 3-4 antibiotics in children with moderate-severe refractory UC and IBD-unclassified including metronidazole, amoxicillin, doxycycline, and if during hospital admission, also vancomycin (MADoV). METHODS: All children treated during 2013 with the antibiotic cocktail for 2-3weeks in an attempt to alleviate inflammation in refractory colitis were included. Doxycycline was substituted with oral gentamycin or ciprofloxacin in children younger than 8years or when an allergy was known to one of the drugs. Children were assessed using the PUCAI and CRP weekly for 3weeks. RESULTS: All 15 included children had moderate to severe disease with refractory disease course to multiple immunosuppressants (mean age 13.6±5.1years, median disease duration 2 (IQR 0.8-3.2) years, 11 females (73%), and 13 (87%) extensive disease; 14 (93%) were corticosteroid-dependent or resistant, and 12 (80%) refractory to anti-TNF therapy). The cocktail was definitely effective in 7 of the 15 included children (47%) who entered complete clinical remission (PUCAI<10) without additional interventions. Questionable or partial short-term response was noted in another 3 (20%), totaling 67% of patients. CONCLUSION: The use of oral wide-spectrum antibiotic cocktail in pediatric UC seems promising in half of patients, refractory to other salvage therapy. A pediatric randomized controlled trial to assess this intervention is underway.
BACKGROUND: The results of previous studies on the effectiveness of antibiotics in ulcerative colitis (UC) seem more effective when used orally. In this retrospective, multicenter study, we aimed to report our experience of using a combination of 3-4 antibiotics in children with moderate-severe refractory UC and IBD-unclassified including metronidazole, amoxicillin, doxycycline, and if during hospital admission, also vancomycin (MADoV). METHODS: All children treated during 2013 with the antibiotic cocktail for 2-3weeks in an attempt to alleviate inflammation in refractory colitis were included. Doxycycline was substituted with oral gentamycin or ciprofloxacin in children younger than 8years or when an allergy was known to one of the drugs. Children were assessed using the PUCAI and CRP weekly for 3weeks. RESULTS: All 15 included children had moderate to severe disease with refractory disease course to multiple immunosuppressants (mean age 13.6±5.1years, median disease duration 2 (IQR 0.8-3.2) years, 11 females (73%), and 13 (87%) extensive disease; 14 (93%) were corticosteroid-dependent or resistant, and 12 (80%) refractory to anti-TNF therapy). The cocktail was definitely effective in 7 of the 15 included children (47%) who entered complete clinical remission (PUCAI<10) without additional interventions. Questionable or partial short-term response was noted in another 3 (20%), totaling 67% of patients. CONCLUSION: The use of oral wide-spectrum antibiotic cocktail in pediatric UC seems promising in half of patients, refractory to other salvage therapy. A pediatric randomized controlled trial to assess this intervention is underway.
Authors: Jessica Breton; Arthur Kastl; Natalie Hoffmann; Rachel Rogers; Andrew B Grossman; Petar Mamula; Judith R Kelsen; Robert N Baldassano; Lindsey Albenberg Journal: Inflamm Bowel Dis Date: 2019-08-20 Impact factor: 5.325
Authors: Stephen M Vindigni; Timothy L Zisman; David L Suskind; Christopher J Damman Journal: Therap Adv Gastroenterol Date: 2016-04-19 Impact factor: 4.409
Authors: Laura E Bauman; Ye Xiong; Tomoyuki Mizuno; Philip Minar; Tsuyoshi Fukuda; Min Dong; Michael J Rosen; Alexander A Vinks Journal: Inflamm Bowel Dis Date: 2020-02-11 Impact factor: 5.325