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Antibiotic Therapy

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Pediatric Inflammatory Bowel Disease

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Abstract

Antibiotics have been well-established tools in the treatment of pediatric inflammatory bowel disease for many years. A wide range of antibiotics have been used for a multitude of indications including induction and maintenance of remission, prevention of postoperative recurrence of disease, and in other special circumstances such as the treatment of perianal Crohn disease. The notion that the gut microbiota plays a fundamental role in the pathogenesis of inflammatory bowel disease supports the approach of treatment with antibiotics. The specific mechanism of action is unknown, but hypotheses include targeting an unknown specific pathogen, preventing immune system stimulation by limiting bacterial translocation, altering the composition of the gut microbiota, and anti-inflammatory properties of the specific antibiotic(s). In this chapter, the data supporting the use of antibiotics in the treatment of inflammatory bowel disease will be described, and emerging therapeutic approaches utilizing antimicrobial medications will be reviewed.

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References

  1. Sartor RB. Pathogenesis and immune mechanisms of chronic inflammatory bowel diseases. Am J Gastroenterol. 1997;92(12 Suppl):5S–11S.

    CAS  PubMed  Google Scholar 

  2. Rutgeerts P, Goboes K, Peeters M, et al. Effect of faecal stream diversion on recurrence of Crohn’s disease in the neoterminal ileum. Lancet. 1991;338(8770):771–4.

    Article  CAS  PubMed  Google Scholar 

  3. Perencevich M, Burakoff R. Use of antibiotics in the treatment of inflammatory bowel disease. Inflamm Bowel Dis. 2006;12(7):651–64.

    Article  PubMed  Google Scholar 

  4. Sartor RB. Therapeutic manipulation of the enteric microflora in inflammatory bowel diseases: antibiotics, probiotics, and prebiotics. Gastroenterology. 2004;126(6):1620–33.

    Article  PubMed  Google Scholar 

  5. Rutgeerts P, Hiele M, Geboes K, et al. Controlled trial of metronidazole treatment for prevention of Crohn's recurrence after ileal resection. Gastroenterology. 1995;108(6):1617–21.

    Article  CAS  PubMed  Google Scholar 

  6. Ursing B, Alm T, Barany F, et al. A comparative study of metronidazole and sulfasalazine for active Crohn’s disease: the cooperative Crohn's disease study in Sweden. II Result. Gastroenterology. 1982;83(3):550–62.

    CAS  PubMed  Google Scholar 

  7. Su JW, Ma JJ, Zhang HJ. Use of antibiotics in patients with Crohn's disease: a systematic review and meta-analysis. J Dig Dis. 2015;16(2):58–66.

    Article  CAS  PubMed  Google Scholar 

  8. Hildebrand H, Berg NO, Hoevels J, Ursing B. Treatment of Crohn's disease with metronidazole in childhood and adolescence. Evaluation of a six months trial. Gastroenterol Clin Biol. 1980;4(1):19–25.

    CAS  PubMed  Google Scholar 

  9. Ursing B, Kamme C. Metronidazole for Crohn’s disease. Lancet. 1975;1(7910):775–7.

    Article  CAS  PubMed  Google Scholar 

  10. Sutherland L, Singleton J, Sessions J, et al. Double blind, placebo controlled trial of metronidazole in Crohn's disease. Gut. 1991;32(9):1071–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Colombel JF, Lemann M, Cassagnou M, et al. A controlled trial comparing ciprofloxacin with mesalazine for the treatment of active Crohn's disease. Groupe d’Etudes Therapeutiques des Affections Inflammatoires Digestives (GETAID). Am J Gastroenterol. 1999;94(3):674–8.

    Article  CAS  PubMed  Google Scholar 

  12. Arnold GL, Beaves MR, Pryjdun VO, Mook WJ. Preliminary study of ciprofloxacin in active Crohn's disease. Inflamm Bowel Dis. 2002;8(1):10–5.

    Article  PubMed  Google Scholar 

  13. Greenbloom SL, Steinhart AH, Greenberg GR. Combination ciprofloxacin and metronidazole for active Crohn's disease. Can J Gastroenterol. 1998;12(1):53–6.

    Article  CAS  PubMed  Google Scholar 

  14. Prantera C, Zannoni F, Scribano ML, et al. An antibiotic regimen for the treatment of active Crohn’s disease: a randomized, controlled clinical trial of metronidazole plus ciprofloxacin. Am J Gastroenterol. 1996;91(2):328–32.

    CAS  PubMed  Google Scholar 

  15. Prantera C, Berto E, Scribano ML, Falasco G. Use of antibiotics in the treatment of active Crohn’s disease: experience with metronidazole and ciprofloxacin. Ital J Gastroenterol Hepatol. 1998;30(6):602–6.

    CAS  PubMed  Google Scholar 

  16. Levine A, Turner D. Combined azithromycin and metronidazole therapy is effective in inducing remission in pediatric Crohn’s disease. J Crohns Colitis. 2011;5(3):222–6.

    Article  PubMed  Google Scholar 

  17. Schwartz DA, Pemberton JH, Sandborn WJ. Diagnosis and treatment of perianal fistulas in Crohn disease. Ann Intern Med. 2001;135(10):906–18.

    Article  CAS  PubMed  Google Scholar 

  18. Bernstein LH, Frank MS, Brandt LJ, Boley SJ. Healing of perineal Crohn’s disease with metronidazole. Gastroenterology. 1980;79(3):599.

    CAS  PubMed  Google Scholar 

  19. Brandt LJ, Bernstein LH, Boley SJ, Frank MS. Metronidazole therapy for perineal Crohn’s disease: a follow-up study. Gastroenterology. 1982;83(2):383–7.

    CAS  PubMed  Google Scholar 

  20. Maeda Y, Ng SC, Durdey P, et al. Randomized clinical trial of metronidazole ointment versus placebo in perianal Crohn's disease. Br J Surg. 2010;97(9):1340–7.

    Article  CAS  PubMed  Google Scholar 

  21. Dejaco C, Harrer M, Waldhoer T, Miehsler W, Vogelsang H, Reinisch W. Antibiotics and azathioprine for the treatment of perianal fistulas in Crohn’s disease. Aliment Pharmacol Ther. 2003;18(11–12):1113–20.

    Article  CAS  PubMed  Google Scholar 

  22. West RL, van der Woude CJ, Hansen BE, et al. Clinical and endosonographic effect of ciprofloxacin on the treatment of perianal fistulae in Crohn’s disease with infliximab: a double-blind placebo-controlled study. Aliment Pharmacol Ther. 2004;20(11–12):1329–36.

    Article  CAS  PubMed  Google Scholar 

  23. Gecse KB, Bemelman W, Kamm MA, et al. A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn’s disease. Gut. 2014;63(9):1381–92.

    Article  PubMed  Google Scholar 

  24. Baldassano RN, Han PD, Jeshion WC, et al. Pediatric Crohn’s disease: risk factors for postoperative recurrence. Am J Gastroenterol. 2001;96(7):2169–76.

    Article  CAS  PubMed  Google Scholar 

  25. Penner RM, Madsen KL, Fedorak RN. Postoperative Crohn’s disease. Inflamm Bowel Dis. 2005;11(8):765–77.

    Article  PubMed  Google Scholar 

  26. D'Haens GR, Geboes K, Peeters M, Baert F, Penninckx F, Rutgeerts P. Early lesions of recurrent Crohn’s disease caused by infusion of intestinal contents in excluded ileum. Gastroenterology. 1998;114(2):262–7.

    Article  PubMed  Google Scholar 

  27. Rutgeerts P, Van Assche G, Vermeire S, et al. Ornidazole for prophylaxis of postoperative Crohn’s disease recurrence: a randomized, double-blind, placebo-controlled trial. Gastroenterology. 2005;128(4):856–61.

    Article  CAS  PubMed  Google Scholar 

  28. Singh S, Garg SK, Pardi DS, Wang Z, Murad MH, Loftus EV, Jr. Comparative efficacy of pharmacologic interventions in preventing relapse of Crohn’s disease after surgery: a systematic review and network meta-analysis. Gastroenterology. 2015;148(1):64–76.e62; quiz e14.

    Google Scholar 

  29. Herfarth HH, Katz JA, Hanauer SB, et al. Ciprofloxacin for the prevention of postoperative recurrence in patients with Crohn’s disease: a randomized, double-blind, placebo-controlled pilot study. Inflamm Bowel Dis. 2013;19(5):1073–9.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Dickinson RJ, O'Connor HJ, Pinder I, Hamilton I, Johnston D, Axon AT. Double blind controlled trial of oral vancomycin as adjunctive treatment in acute exacerbations of idiopathic colitis. Gut. 1985;26(12):1380–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Chapman RW, Selby WS, Jewell DP. Controlled trial of intravenous metronidazole as an adjunct to corticosteroids in severe ulcerative colitis. Gut. 1986;27(10):1210–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Mantzaris GJ, Archavlis E, Christoforidis P, et al. A prospective randomized controlled trial of oral ciprofloxacin in acute ulcerative colitis. Am J Gastroenterol. 1997;92(3):454–6.

    CAS  PubMed  Google Scholar 

  33. Turunen UM, Farkkila MA, Hakala K, et al. Long-term treatment of ulcerative colitis with ciprofloxacin: a prospective, double-blind, placebo-controlled study. Gastroenterology. 1998;115(5):1072–8.

    Article  CAS  PubMed  Google Scholar 

  34. Gilat T, Suissa A, Leichtman G, et al. A comparative study of metronidazole and sulfasalazine in active, not severe, ulcerative colitis. An Israeli multicenter trial. J Clin Gastroenterol. 1987;9(4):415–7.

    Article  CAS  PubMed  Google Scholar 

  35. Burke DA, Axon AT, Clayden SA, Dixon MF, Johnston D, Lacey RW. The efficacy of tobramycin in the treatment of ulcerative colitis. Aliment Pharmacol Ther. 1990;4(2):123–9.

    Article  CAS  PubMed  Google Scholar 

  36. Lobo AJ, Burke DA, Sobala GM, Axon AT. Oral tobramycin in ulcerative colitis: effect on maintenance of remission. Aliment Pharmacol Ther. 1993;7(2):155–8.

    Article  CAS  PubMed  Google Scholar 

  37. Mantzaris GJ, Hatzis A, Kontogiannis P, Triadaphyllou G. Intravenous tobramycin and metronidazole as an adjunct to corticosteroids in acute, severe ulcerative colitis. Am J Gastroenterol. 1994;89(1):43–6.

    CAS  PubMed  Google Scholar 

  38. Ohkusa T, Nomura T, Terai T, et al. Effectiveness of antibiotic combination therapy in patients with active ulcerative colitis: a randomized, controlled pilot trial with long-term follow-up. Scand J Gastroenterol. 2005;40(11):1334–42.

    Article  CAS  PubMed  Google Scholar 

  39. Ohkusa T, Okayasu I, Ogihara T, Morita K, Ogawa M, Sato N. Induction of experimental ulcerative colitis by Fusobacterium varium isolated from colonic mucosa of patients with ulcerative colitis. Gut. 2003;52(1):79–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Uehara T, Kato K, Ohkusa T, et al. Efficacy of antibiotic combination therapy in patients with active ulcerative colitis, including refractory or steroid-dependent cases. J Gastroenterol Hepatol. 2010;25(Suppl 1):S62–6.

    Article  CAS  PubMed  Google Scholar 

  41. Turner D, Levine A, Kolho KL, Shaoul R, Ledder O. Combination of oral antibiotics may be effective in severe pediatric ulcerative colitis: a preliminary report. J Crohns Colitis. 2014;8(11):1464–70.

    Article  PubMed  Google Scholar 

  42. Gupta V, Rodrigues R, Nguyen D, et al. Adjuvant use of antibiotics with corticosteroids in inflammatory bowel disease exacerbations requiring hospitalisation: a retrospective cohort study and meta-analysis. Aliment Pharmacol Ther. 2016;43(1):52–60.

    Article  CAS  PubMed  Google Scholar 

  43. Shafran I, Johnson LK. An open-label evaluation of rifaximin in the treatment of active Crohn’s disease. Curr Med Res Opin. 2005;21(8):1165–9.

    Article  CAS  PubMed  Google Scholar 

  44. Shafran I, Burgunder P. Adjunctive antibiotic therapy with rifaximin may help reduce Crohn’s disease activity. Dig Dis Sci. 2010;55(4):1079–84.

    Article  CAS  PubMed  Google Scholar 

  45. Prantera C, Lochs H, Grimaldi M, et al. Rifaximin-extended intestinal release induces remission in patients with moderately active Crohn’s disease. Gastroenterology. 2012;142(3):473–81.e474.

    Article  CAS  PubMed  Google Scholar 

  46. Gionchetti P, Rizzello F, Ferrieri A, et al. Rifaximin in patients with moderate or severe ulcerative colitis refractory to steroid-treatment: a double-blind, placebo-controlled trial. Dig Dis Sci. 1999;44(6):1220–1.

    Article  CAS  PubMed  Google Scholar 

  47. Guslandi M, Giollo P, Testoni PA. Corticosteroid-sparing effect of rifaximin, a nonabsorbable oral antibiotic, in active ulcerative colitis: Preliminary clinical experience. Curr Ther Res Clin Exp. 2004;65(3):292–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Guslandi M, Petrone MC, Testoni PA. Rifaximin for active ulcerative colitis. Inflamm Bowel Dis. 2006;12(4):335.

    Article  PubMed  Google Scholar 

  49. Shen B, Achkar JP, Lashner BA, et al. A randomized clinical trial of ciprofloxacin and metronidazole to treat acute pouchitis. Inflamm Bowel Dis. 2001;7(4):301–5.

    Article  CAS  PubMed  Google Scholar 

  50. Shen B, Remzi FH, Lopez AR, Queener E. Rifaximin for maintenance therapy in antibiotic-dependent pouchitis. BMC Gastroenterol. 2008;8:26.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Gionchetti P, Rizzello F, Venturi A, et al. Antibiotic combination therapy in patients with chronic, treatment-resistant pouchitis. Aliment Pharmacol Ther. 1999;13(6):713–8.

    Article  CAS  PubMed  Google Scholar 

  52. Isaacs KL, Sandler RS, Abreu M, et al. Rifaximin for the treatment of active pouchitis: a randomized, double-blind, placebo-controlled pilot study. Inflamm Bowel Dis. 2007;13(10):1250–5.

    Article  PubMed  Google Scholar 

  53. Muniyappa P, Gulati R, Mohr F, Hupertz V. Use and safety of rifaximin in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2009;49(4):400–4.

    Article  CAS  PubMed  Google Scholar 

  54. Smith S, Shaw J, Nathwani D. Nitazoxanide for cryptosporidial infection in Crohn’s disease. Gut. 2008;57(8):1179–80.

    CAS  PubMed  Google Scholar 

  55. Davies YK, Cox KM, Abdullah BA, Safta A, Terry AB, Cox KL. Long-term treatment of primary sclerosing cholangitis in children with oral vancomycin: an immunomodulating antibiotic. J Pediatr Gastroenterol Nutr. 2008;47(1):61–7.

    Article  CAS  PubMed  Google Scholar 

  56. Duffy LF, Daum F, Fisher SE, et al. Peripheral neuropathy in Crohn’s disease patients treated with metronidazole. Gastroenterology. 1985;88(3):681–4.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA

    Lindsey Albenberg DO

  2. Division of Pediatric Gastroenterology, Hepatology, and Nutrition, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Lindsey Albenberg DO

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

    Howard Kader MD

  4. Lehigh Valley Children’s Hospital, Allentown, PA, USA

    Adam Paul DO

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  1. Lindsey Albenberg DO
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  2. Howard Kader MD
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  3. Adam Paul DO
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Corresponding author

Correspondence to Lindsey Albenberg DO .

Editor information

Editors and Affiliations

  1. Division of GI, Hepatology & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Petar Mamula

  2. Division of GI, Hepatology & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Andrew B. Grossman

  3. Division of GI, Hepatology & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Robert N. Baldassano

  4. Division of GI, Hepatology & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Judith R. Kelsen

  5. Division of Pediatric Gastroenterology & Nutrition, University of South Carolina School of Medicine - Greenville, Greenville, South Carolina, USA

    Jonathan E. Markowitz

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Albenberg, L., Kader, H., Paul, A. (2017). Antibiotic Therapy. In: Mamula, P., Grossman, A., Baldassano, R., Kelsen, J., Markowitz, J. (eds) Pediatric Inflammatory Bowel Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-49215-5_26

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  • DOI: https://doi.org/10.1007/978-3-319-49215-5_26

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