The role of anti(myco)bacterial interventions in the management of IBD: is there evidence at all?
OBJECTIVE
The etiology of IBD is unknown but may relate to an unidentified bacterial pathogen or an immunological reaction to gut microbiota. Antibiotics have therefore been proposed as a therapy for Crohn's disease (CD) and ulcerative colitis (UC). The aim of this review was to compel the evidence for the use of antibiotics in the treatment of IBD.


METHODS
We performed a systematic review of the literature regarding the use of antibiotics for inducing or maintaining remission in IBD.


RESULTS
Current data are conflicting, but a recent systematic review of randomized controlled trials has shown a statistically significant effect of antibiotics being superior to placebo for active, perianal and quiescent CD and for active UC. These data have been poorly translated in clinical practice and the place of antibiotics is restricted to certain specific situations in the international guidelines. This is first linked to the difficulties in interpreting clinical trials because of their heterogeneity in study design, endpoints, type of antibiotic and concomitant therapies. The exception to this is the use of either ciprofloxacin or metronidazole for treating CD perianal fistulas.


CONCLUSIONS
The pathology of CD, the likely primary and known secondary pathogens in this disease and the successful responses in animal models all plead for new trials of antibiotics in IBD. This is a call to select patients more carefully, and to continue antibiotics for longer than is customary. Beside antibiotics, new therapeutic approaches that can balance gut dysbiosis should be tested.
Université Lille Nord de France, Lille, France.
Guillaume P
GP
Pineton de Chambrun
Joana
J
Torres
Arlette
A
Darfeuille-Michaud
Jean-Frédéric
JF
Colombel
D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000382:microbiology; D003424:Crohn Disease / Q000188:drug therapy / Q000382:microbiology; D006287:Health Planning Guidelines; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000382:microbiology* / Q000601:surgery; D019449:Pouchitis / Q000188:drug therapy
D000900:Anti-Bacterial Agents