Oral combination antibiotics appeared to be an effective rescue therapy in children with inflammatory bowel disease who were failing a biologic, according to research published in Inflammatory Bowel Diseases.
Lindsey Albenberg, DO, of the division of pediatric gastroenterology at Children’s Hospital of Philadelphia, and colleagues wrote that research over the course of the last 10 years has helped improve the understanding of how the gut microbiota contributes to intestinal inflammation.
“Although the role of the gut microbiota in IBD has been increasingly recognized, our current therapeutic strategies continue to target the immune system rather than the dysbiosis,” they wrote. “In recent years, interest in the use of broad-spectrum antibiotics as salvage therapy in refractory colitis has been growing, with a few clinical studies suggesting a potential, but still unclear, role in these evolving strategies.”
Researchers evaluated the impact of oral combination antibiotics on clinical response, disease activity indices and clinical outcomes in a retrospective study of 63 children with refractory IBD.
Patients in the study had refractory ulcerative colitis, Crohn’s colitis or unclassified IBD and received a combination of three or four antibiotics for a median of 29 days. Most of the patients (62/63) had current or previous loss of response or primary nonresponse to anti-TNF, and 34 patients were corticosteroid refractory or dependent.
Researchers found that the antibiotic therapy led to a decrease in median Pediatric Ulcerative Colitis Activity Index (PUCAI) score over 3±1 weeks (55 to 10; P < .0001). Additionally, 39.7% of patients achieved clinical remission defined as a PUCAI score of less than 10 points.
After one year of follow-up, only one patient who achieved clinical remission required surgery compared with 10 patients who did not respond to the antibiotic therapy.
Albenberg and colleagues also found that the antibiotic therapy helped patients taper or withdrawal from corticosteroids.
“Combination antibiotic therapy therefore appears to be a valuable steroid-sparing option for short-term control of active disease in refractory pediatric colitis,” they wrote. “This therapy could be positioned as an effective bridging strategy while transitioning patients to medications that have delayed onset of demonstrable efficacy, such as vedolizumab.” – by Alex Young
Disclosures: Albenberg reports that she has received research funding from Seres Therapeutics. Please see the full study for all other authors’ relevant financial disclosures.