Abstract
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 <10 points). The clinical benefits of oral antibiotics were independent of anti-TNFα therapy optimization. Among children entering clinical remission (n = 25), only 1 patient required surgery at 1-year follow-up, vs 10 patients in the nonresponder group. Negative predictors of response to combination antibiotics were exposure to doxycycline (odds ratio [OR], 0.25; 95% CI, 0.08-0.76) and PUCAI ≥65 at baseline (OR, 0.2; 95% CI, 0.05-0.74). 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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1586-1593 |
| Number of pages | 8 |
| Journal | Inflammatory bowel diseases |
| Volume | 25 |
| Issue number | 9 |
| DOIs | |
| State | Published - Sep 1 2019 |
Funding
Received for publications October 5, 2018; Editorial Decision December 28, 2018. From the Divisions of *Gastroenterology and †General Pediatrics, Children’s Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; ‡Biostatistics and Data Management Core, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Author contributions: No writing assistance was provided, and all views expressed in this manuscript are those of the authors. The authors jointly drafted and edited the manuscript. Supported by: This work was supported in part by National Institutes of Health grant K23 DK109136. Conflicts of interest: L. A. received research funding from Seres Therapeutics. R. N. B. has served as a consultant for AbbVie, Celgene, Janssen, Pfizer and Eli Lilly. J. B., A. K., N. H., P. M., A. B. G. and J. R. K. as well as Rachel Rogers report no potential conflicts of interest. Address correspondence to: Lindsey Albenberg, DO, Division of Pediatric Gastroenterology, Children’s Hospital of Philadelphia Roberts Center, 14-140 2716 South St, Philadelphia, PA, 19146 ([email protected]). © 2019 Crohn’s & Colitis Foundation. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [email protected]. doi: 10.1093/ibd/izz006 Published online 4 February 2019
Keywords
- acute severe colitis
- antibiotics
- pediatric inflammatory bowel disease
- refractory colitis
ASJC Scopus subject areas
- Immunology and Allergy
- Gastroenterology