Antibiotics and probiotics in inflammatory bowel disease: why, when, and how.
OBJECTIVE
To summarize recent evidence on the role of intestinal bacteria in inflammatory bowel diseases, and of antibiotics and probiotics in their treatment. The implications connected with the use of antibiotics are also examined.


RESULTS
The hypothesis that Mycobacterium paratuberculosis could be a causative agent of Crohn's disease has not been confirmed by a large trial on symptomatic patients treated by a combination of antibiotics active against this bacterium. An increased number of adherent-invasive Escherichia coli have been found in the intestinal tissue of patients with Crohn's disease, but their role in the pathogenesis of this condition remains to be defined. The combination of metronidazole and azathioprine, associating the effects of a reduced bacterial load with immunosuppression, appears to be a therapeutic option to decrease the recurrence of postoperative Crohn's disease in high-risk patients. However, concerns are raised by the possibility that antibiotics may induce disease relapse due to Clostridium difficile infection.


CONCLUSIONS
Recent literature provides increasing support for the use of antibiotics in Crohn's disease, although the side effects limit their long-term use. The efficacy of antibiotics in ulcerative colitis is not confirmed by the available literature, except in severe colitis. More trials are needed to support the use of probiotics as therapy in inflammatory bowel disease.
Prantera
Cosimo
C
Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.
Scribano
Maria Lia
ML
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016360:Clostridioides difficile / Q000187:drug effects / Q000302:isolation & purification; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology; D003424:Crohn Disease / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000382:microbiology* / Q000503:physiopathology; D007413:Intestinal Mucosa / Q000187:drug effects / Q000382:microbiology; D008297:Male; D008826:Microbial Sensitivity Tests; D016927:Mycobacterium avium subsp. paratuberculosis / Q000187:drug effects / Q000302:isolation & purification; D019936:Probiotics / Q000008:administration & dosage*; D018570:Risk Assessment; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents