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Antibiotic Therapy

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Pediatric Inflammatory Bowel Disease

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Abstract

Treatment of inflammatory bowel disease (IBD) with antibiotics has been used for several decades and the mechanisms by which certain aspects of bacteria will trigger an immune response leading to intestinal mucosal inflammation are continuously being described. In susceptible individuals perpetual intestinal mucosal inflammation results in clinical symptoms of IBD given a triad relationship: genetic susceptibility–environmental antigen–host immune response. Antibiotics therefore possess the ability to change the course of IBD in a variety of ways including reducing luminal bacterial content, changing the microflora of the colon, reducing bacterial invasion of intestinal tissue, and limiting bacterial translocation.

Unfortunately, there are no randomized therapeutic antibiotic studies that have been performed in children with IBD to assess the efficacy and validity of their use. Most reported pediatric studies have at best mentioned that concurrent antibiotic use was permitted if already taking it during that specific study involving another medication intervention. Consequently, the pediatric gastroenterologist has to extrapolate from and rely on adult evidence-based medicine clinical trials. This chapter will review the published literature available at this time on antibiotic therapy in both Crohn’s disease and ulcerative colitis (UC) as it pertains to induction of remission, maintenance of remission, penetrating/fistulizing disease, and postoperative treatment for Crohn’s disease and its utilization in ulcerative colitis for both induction of remission and maintenance of remission. Postoperative pouchitis treatment will not be addressed in this chapter.

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, University of Maryland School of Medicine, University of Maryland Children’s Hospital, 22 S. Greene Street, Room N5W70, Baltimore, MD, 21201-1595, USA

    Howard Kader MD

  2. Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, Sinai Hospital of Baltimore, Baltimore, MD, USA

    Douglas Jacobstein MD

  3. Department of Pediatric Gastroenterology, University of Maryland Children’s Hospital, Baltimore, MD, USA

    Adam Paul DO

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  1. Howard Kader MD
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  2. Douglas Jacobstein MD
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  3. Adam Paul DO
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Correspondence to Howard Kader MD .

Editor information

Editors and Affiliations

  1. Perelman School of Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, 34th St. & Civic Ctr. Blvd., Philadelphia, 19104, Pennsylvania, USA

    Petar Mamula

  2. School of Medicine--Greenville, Pediatric Gastroenterology & Nutrition, University of South Carolina, 200 Patewood Drive, Suite A-140, Greenville, 29615, South Carolina, USA

    Jonathan E. Markowitz

  3. Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 34th St. & Civic Ctr. Blvd., Philadelphia, 19104, Pennsylvania, USA

    Robert N. Baldassano

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Kader, H., Jacobstein, D., Paul, A. (2013). Antibiotic Therapy. In: Mamula, P., Markowitz, J., Baldassano, R. (eds) Pediatric Inflammatory Bowel Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5061-0_27

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  • DOI: https://doi.org/10.1007/978-1-4614-5061-0_27

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