title: What is the evidence for prophylactic antibiotic treatment in patients with systemic vasculitides?
abstract: OBJECTIVE
  Microbial factors are supposed to play an inducing and/or reactivating role in many of the idiopathic systemic vasculitides. This review evaluates the evidence that microbes are involved in the etiopathogenesis of the disease focusing on possibilities for antimicrobial intervention.
  
  
  RESULTS
  The clinical presentation of hepatitis B virus (HBV)-associated polyarteritis nodosa (PAN) is different from that of non-HBV-PAN and requires antiviral treatment. In hepatitic C virus (HCV)-associated autoimmune diseases, type 2 cryoglobulinemia is present in 52% of cases. Chronic nasal carriage of Staphylococcus aureus is related to endonasal activity of Wegener's granulomatosis and recurrent relapses, and prophylactic treatment with co-trimoxazole is effective in reducing relapse rate.
  
  
  CONCLUSIONS
  Patients with PAN should be tested for HBV, and patients with type 2 cryoglobulinemia for HCV. When tested positive, antiviral treatment should be considered. Patients with Wegener's granulomatosis should be tested for nasal carriage of S. aureus, and prophylactic treatment with co-trimoxazole should be considered in case of persistent endonasal activity of Wegener's granulomatosis together with S. aureus carriage. The efficacy of S. aureus elimination for preventing relapses of Wegener's granulomatosis should be evaluated.
authors.affiliation: Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. c.g.m.kallenberg@reuma.umcg.nl
authors.forename: Cees G M
authors.initials: CG
authors.lastname: Kallenberg
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000378:metabolism; D000936:Antigen-Antibody Complex / Q000378:metabolism; D014890:Granulomatosis with Polyangiitis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D010488:Polyarteritis Nodosa / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D012008:Recurrence; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy; D056647:Systemic Vasculitis / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D019268:Antibodies, Antineutrophil Cytoplasmic; D000936:Antigen-Antibody Complex