ABSTRACT

Objectives: To ascertain the role of antibiotics in induction and maintenance of remission in ulcerative colitis (UC)

Methods: We searched electronic databases for keywords ulcerative colitis or inflammatory bowel disease and antibiotics or antimicrobials. We performed a meta-analysis of randomized trials comparing antibiotics with control/placebo for clinical response, need for second line therapy, colectomy, and adverse effects. Subgroup analysis to clarify the mode of administration, number of antibiotics or the setting of use (acute severe UC or active non–severe UC) were also performed.

Results: Thirteen trials with 785 patients were included. The pooled odds ratio of achieving clinical response with antibiotics was 1.74 (95% CI, 1.17-2.58). No differences were noted in relapse rates, need for second line therapy, colectomy or, adverse effects with the use of antibiotics. Subgroup analysis showed no differences with use of single or combination of antibiotics. Analysis of trials only in the setting of acute severe colitis did not demonstrate any benefit.

Conclusion: The use of oral antibiotics in the setting of non-severe active UC could have some benefit in clinical response. The use of antibiotics is not of benefit in acute severe colitis, but oral antibiotics need to be evaluated in adult patients.

摘要

目的：确定抗生素在溃疡性结肠炎 (UC) 诱导和维持缓解中的作用

方法：我们在电子数据库中搜索关键词溃疡性结肠炎或炎症性肠病和抗生素或抗微生物药物。我们对比较抗生素与对照/安慰剂的临床反应、二线治疗需求、结肠切除术和不良反应的随机试验进行了荟萃分析。还进行了亚组分析，以阐明给药方式、抗生素数量或使用环境（急性重症 UC 或活动性非重症 UC）。

结果：纳入了 785 名患者的 13 项试验。使用抗生素达到临床反应的综合优势比为 1.74（95% CI，1.17-2.58）。在复发率、二线治疗需求、结肠切除术或使用抗生素的副作用方面没有发现差异。亚组分析显示使用单一或联合使用抗生素没有差异。仅在急性重症结肠炎背景下进行的试验分析并未显示任何益处。

结论：在非严重活动性 UC 的情况下使用口服抗生素可能对临床反应有一定的益处。使用抗生素对急性重症结肠炎没有好处，但需要对成年患者的口服抗生素进行评估。