ABSTRACT

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.

摘要

简介：目前小儿炎症性肠病 (IBD) 的治疗针对免疫系统，通常无法维持长期缓解。非常需要开发替代治疗策略，例如儿科 IBD 中的抗生素。

涵盖领域：本研究系统地评估了抗生素在儿科 IBD 中的有效性和安全性。在 CENTRAL、EMBASE 和 Medline 中搜索了随机对照试验 (RCT)。使用 Cochrane 偏倚风险工具进行质量评估。

专家意见：包括两个 RCT（n = 101，4.4-18 岁，43% 男性）。这两项研究的总体偏倚风险较低。在轻度至中度克罗恩病中，阿奇霉素 + 甲硝唑 (AZ+MET) (n = 35) 与单独的甲硝唑 (MET) (n = 38) 相比，没有引起显着不同的反应（PCDAI 下降≥12.5 或缓解）（ p = 0.07）。对于诱导缓解（PCDAI≤10），AZ+MET 比 MET 更有效（p = 0.025）。在急性重度结肠炎中，抗生素（万古霉素、阿莫西林、甲硝唑、强力霉素）+静脉内皮质类固醇组 (AB+IVCS) (n = 16) 的平均 5 天 PUCAI 显着低于单独的 IVCS (n = 12) (p = 0.037)，而缓解 (PUCAI<10) 没有差异 (p = 0.61)。没有报告显着的药物相关不良事件。这项抗生素使用系统评价的结果强调了儿童 IBD 缺乏证据。在日常实践中广泛实施之前，还需要更多的证据。