title: Combination of oral antibiotics may be effective in severe pediatric ulcerative colitis: a preliminary report.
abstract: BACKGROUND
  The results of previous studies on the effectiveness of antibiotics in ulcerative colitis (UC) seem more effective when used orally. In this retrospective, multicenter study, we aimed to report our experience of using a combination of 3-4 antibiotics in children with moderate-severe refractory UC and IBD-unclassified including metronidazole, amoxicillin, doxycycline, and if during hospital admission, also vancomycin (MADoV).
  
  
  METHODS
  All children treated during 2013 with the antibiotic cocktail for 2-3weeks in an attempt to alleviate inflammation in refractory colitis were included. Doxycycline was substituted with oral gentamycin or ciprofloxacin in children younger than 8years or when an allergy was known to one of the drugs. Children were assessed using the PUCAI and CRP weekly for 3weeks.
  
  
  RESULTS
  All 15 included children had moderate to severe disease with refractory disease course to multiple immunosuppressants (mean age 13.6±5.1years, median disease duration 2 (IQR 0.8-3.2) years, 11 females (73%), and 13 (87%) extensive disease; 14 (93%) were corticosteroid-dependent or resistant, and 12 (80%) refractory to anti-TNF therapy). The cocktail was definitely effective in 7 of the 15 included children (47%) who entered complete clinical remission (PUCAI<10) without additional interventions. Questionable or partial short-term response was noted in another 3 (20%), totaling 67% of patients.
  
  
  CONCLUSIONS
  The use of oral wide-spectrum antibiotic cocktail in pediatric UC seems promising in half of patients, refractory to other salvage therapy. A pediatric randomized controlled trial to assess this intervention is underway.
authors: The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel. Electronic address: turnerd@szmc.org.il.
authors: Dan
authors: D
authors: Turner
authors: Wolfson Medical Center, Holon, Israel.
authors: Arie
authors: A
authors: Levine
authors: Pediatric Gastroenterology, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland.
authors: Kaija-Leena
authors: KL
authors: Kolho
authors: Pediatric Gastroenterology Unit, Rambam Medical Center, Haifa, Israel.
authors: Ron
authors: R
authors: Shaoul
authors: The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel.
authors: Oren
authors: O
authors: Ledder
mesh_terms: D000293:Adolescent; D000658:Amoxicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D003093:Colitis, Ulcerative / Q000097:blood / Q000188:drug therapy*; D004318:Doxycycline / Q000627:therapeutic use*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D012074:Remission Induction; D019233:Retreatment; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D008795:Metronidazole; D014640:Vancomycin; D000658:Amoxicillin; D002097:C-Reactive Protein; D004318:Doxycycline
keywords: Antibiotics; Children; Doxycyline; Severe UC; Ulcerative colitis; Vancomycin