Efficacy of Combination Antibiotic Therapy for Refractory Pediatric Inflammatory Bowel Disease
| Autor: | Jessica Breton, Judith R. Kelsen, Natalie Hoffmann, Lindsey Albenberg, Robert N. Baldassano, Rachel Rogers, Andrew B. Grossman, Arthur Kastl, Petar Mamula |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Adolescent medicine.drug_class Antibiotics Drug Resistance Salvage therapy Severity of Illness Index Inflammatory bowel disease Gastroenterology 03 medical and health sciences 0302 clinical medicine Interquartile range Internal medicine Humans Immunology and Allergy Medicine Colitis Child Retrospective Studies business.industry Future Directions Remission Induction Retrospective cohort study Bacterial Infections Inflammatory Bowel Diseases Prognosis medicine.disease Ulcerative colitis Anti-Bacterial Agents Metronidazole Child Preschool 030220 oncology & carcinogenesis Drug Therapy Combination Female 030211 gastroenterology & hepatology business Immunosuppressive Agents Follow-Up Studies medicine.drug |
| Zdroj: | Inflamm Bowel Dis |
| ISSN: | 1536-4844 1078-0998 |
| Popis: | Background Recent studies have shown that oral combination antibiotics may improve disease course in refractory inflammatory bowel disease (IBD). Here, we describe the use of combination oral antibiotics as salvage therapy in refractory ulcerative colitis (UC), Crohn’s colitis, and IBD-unclassified (IBD-U) at a large pediatric IBD center. Methods Clinical response, disease activity indices, adverse events, and clinical outcomes were measured up to 1 year after antibiotic treatment in this retrospective cohort study of children with medically refractory IBD colitis. Results Sixty-three patients with refractory UC, Crohn’s colitis, and IBD-U (median age [interquartile range {IQR}], 15.3 [11.2–16.5] years; median disease duration [IQR], 1.2 [0.41–4.6] years) received a combination of 3 or 4 oral antibiotics (most commonly amoxicillin, metronidazole, and either doxycycline or ciprofloxacin) for a median (IQR) of 29 (21–58) days. Thirty-four patients (54%) were deemed corticosteroid-refractory or -dependent, with the majority (62/63) having a previous or present loss of response or primary nonresponse to anti–tumor necrosis factor alpha (anti-TNFα) therapy. Use of combination antibiotics led to a significant decrease in median Pediatric Ulcerative Colitis Activity Index (PUCAI) score (IQR) from 55 (40–65) to 10 (0–40; P < 0.0001) over 3 ± 1 weeks, with 25/63 (39.7%) patients achieving clinical remission (PUCAI Conclusions Oral combination antibiotics appears to be an effective rescue and steroid-sparing therapy to induce remission in the short term in patients failing a biologic. |
| Databáze: | OpenAIRE |
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