The Role of Anti(myco)bacterial Interventions in the Management of IBD: Is There Evidence at All
Digestive Diseases, 07/31/2012
de Chambrun CPP et al. – The pathology of Crohn’s disease (CD), the likely primary and known secondary pathogens in this disease and the successful responses in experimental models all plead for new trials of antibiotics in IBD. This is a call to select patients more carefully, and to continue antibiotics for longer than is customary. Beside antibiotics, new therapeutic approaches that can balance gut dysbiosis should be tested.Methods
- The authors performed a systematic review of the literature regarding the use of antibiotics for inducing or maintaining remission in IBD.
- Current data are conflicting, but a recent systematic review of randomized controlled trials has shown a statistically significant effect of antibiotics being superior to placebo for active, perianal and quiescent CD and for active UC.
- These data have been poorly translated in clinical practice and the place of antibiotics is restricted to certain specific situations in the international guidelines.
- This is first linked to the difficulties in interpreting clinical trials because of their heterogeneity in study design, endpoints, type of antibiotic and concomitant therapies.
- The exception to this is the use of either ciprofloxacin or metronidazole for treating CD perianal fistulas.