TY - JOUR
T1 - Antibiotics in pediatric inflammatory bowel diseases: a systematic review
AU - Verburgt, Charlotte M.
AU - Heutink, W. Pepijn
AU - Kuilboer, Lot I. M.
AU - Dickmann, Julie D.
AU - van Etten-Jamaludin, Faridi S.
AU - Benninga, Marc A.
AU - de Jonge, Wouter J.
AU - van Limbergen, Johan E.
AU - Tabbers, Merit M.
N1 - Funding Information: JE Van Limbergen reports consulting, travel, and/or speaker fees and research support from AbbVie, Janssen, Nestlé Health Science, Novalac, Pfizer, Merck, P&G, GSK, Illumina, and Otsuka. WJ de Jonge is funded by the Dutch Ministery of Economic Affairs, LSH-TKI, Health Holland. M Benninga is consultant for Shire, Norgine, Coloplast, Danone, Takeda, Allergan, Shire, FrieslandCampina, United Pharamceuticals. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Publisher Copyright: © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - Introduction: Current therapies in pediatric Inflammatory Bowel Diseases (IBD) target the immune system and often fail to sustain long-term remission. There is a high need for development of alternative treatment strategies such as antibiotics in pediatric IBD. Areas covered: This study systematically assessed efficacy and safety of antibiotics in pediatric IBD. CENTRAL, EMBASE, and Medline were searched for Randomized Controlled Trials (RCTs). Quality assessment was conducted with the Cochrane risk-of-bias tool. Expert opinion: Two RCTs (n = 101, 4.4–18 years, 43% male) were included. Both studies had overall low risk of bias. In mild-to-moderate Crohn’s disease, azithromycin+metronidazole (AZ+MET) (n = 35) compared to metronidazole (MET) alone (n = 38) did not induce a significantly different response (PCDAI drop ≥12.5 or remission) (p = 0.07). For induction of remission (PCDAI≤10), AZ+MET was more effective than MET (p = 0.025). In Acute Severe Colitis, mean 5-day-PUCAI was significantly lower in the antibiotic (vancomycin, amoxicillin, metronidazole, doxycycline)+intravenous-corticosteroids group (AB+IVCS) (n = 16) compared to IVCS alone (n=12) (p = 0.037), whereas remission (PUCAI<10) did not differ (p = 0.61). No significant drug-related adverse events were reported. Results of this systematic review of antibiotic use highlight the lack of evidence in pediatric IBD. More evidence is needed before widespread implementation in daily practice.
AB - Introduction: Current therapies in pediatric Inflammatory Bowel Diseases (IBD) target the immune system and often fail to sustain long-term remission. There is a high need for development of alternative treatment strategies such as antibiotics in pediatric IBD. Areas covered: This study systematically assessed efficacy and safety of antibiotics in pediatric IBD. CENTRAL, EMBASE, and Medline were searched for Randomized Controlled Trials (RCTs). Quality assessment was conducted with the Cochrane risk-of-bias tool. Expert opinion: Two RCTs (n = 101, 4.4–18 years, 43% male) were included. Both studies had overall low risk of bias. In mild-to-moderate Crohn’s disease, azithromycin+metronidazole (AZ+MET) (n = 35) compared to metronidazole (MET) alone (n = 38) did not induce a significantly different response (PCDAI drop ≥12.5 or remission) (p = 0.07). For induction of remission (PCDAI≤10), AZ+MET was more effective than MET (p = 0.025). In Acute Severe Colitis, mean 5-day-PUCAI was significantly lower in the antibiotic (vancomycin, amoxicillin, metronidazole, doxycycline)+intravenous-corticosteroids group (AB+IVCS) (n = 16) compared to IVCS alone (n=12) (p = 0.037), whereas remission (PUCAI<10) did not differ (p = 0.61). No significant drug-related adverse events were reported. Results of this systematic review of antibiotic use highlight the lack of evidence in pediatric IBD. More evidence is needed before widespread implementation in daily practice.
KW - Antibiotics
KW - inflammatory bowel disease
KW - pediatrics
KW - systematic review
KW - treatment
UR - http://www.scopus.com/inward/record.url?scp=85109800101&partnerID=8YFLogxK
U2 - https://doi.org/10.1080/17474124.2021.1940956
DO - https://doi.org/10.1080/17474124.2021.1940956
M3 - Article
C2 - 34148466
SN - 1747-4124
VL - 15
SP - 891
EP - 908
JO - Expert review of gastroenterology and hepatology
JF - Expert review of gastroenterology and hepatology
IS - 8
ER -