Controlled trial of antimycobacterial therapy in Crohn's disease

Afdhal, Nezam H.; Long, Amanda; Lennon, J.; Crowe, J.; O’Donoghue, Diarmuid

doi:10.1007/bf01298873

Cited by 77 publications

(40 citation statements)

References 31 publications

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“…us, although antibiotics are widely used in clinical practice for the treatment of CD (see perianal disease), controlled trials have not consistently demonstrated e cacy in the setting of luminal disease. Two small placebocontrolled trials of anti-mycobacterial therapy in combination with corticosteroid taper (a er a steroid-induced remission) demonstrated e cacy for the maintenance of remission in patients receiving either clofazimine monotherapy or combination therapy with clofazimine, ethambutol, rifampicin, and dapsone (110,111) . In contrast, ve placebo-controlled trials using combinations of anti-mycobacterial agents alone without concurrent conventional corticosteroids have not demonstrated short-or long-term e cacy using varying combinations of medications, including rifampin, ethambutol, isoniazid, sulphadoxine, pyrimethamine, and rifabutin.…”

Section: Mild To Moderate Active Diseasementioning

confidence: 99%

Management of Crohn's Disease in Adults

2009

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Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifi cally valid research, derived from extensive review of published literature. When data that will withstand objective scrutiny are not available, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be fl exible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are infl exible and rarely violated. Given the wide range of choices in any health-care problem, the physician should select the course best suited to the individual patient and the clinical situation presented. These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. Expert opinion is solicited from the outset for the document. The quality of evidence upon which a specifi c recommendation is based is as follows: Grade A: Homogeneous evidence from multiple well-designed randomized (therapeutic) or cohort (descriptive) controlled trials, each involving a number of participants to be of suffi cient statistical power. Grade B: Evidence from at least one large well-designed clinical trial with or without randomization, from cohort or case -control analytic studies, or well-designed meta-analysis. Grade C: Evidence based on clinical experience, descriptive studies, or reports of expert committees. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fi elds. The fi nal recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientifi c developments at a later time.

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Section: Mild To Moderate Active Diseasementioning

confidence: 99%

Management of Crohn's Disease in Adults

2009

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“…A 2011 meta-analysis [14] identified 10 RCTs (1,160 patients) that evaluated the efficacy of antibiotic therapy for induction of remission of moderately active luminal CD [41,42,43,44,45,46,47,48,49,50]. Antibiotics were given for 4–16 weeks.…”

Section: Review Of the Evidencementioning

confidence: 99%

“…Three RCTs evaluating the efficacy of different antimycobacterial therapies and including patients with quiescent CD (n = 186) were analyzed in the 2011 meta-analysis [41,46,48]. The follow-up was for 9–12 months and the pooled results of these studies demonstrated a significant effect of antibiotics in preventing CD relapse compared to a placebo (RR of relapse = 0.62, 95% CI = 0.46–0.84) [14].…”

Section: Review Of the Evidencementioning

confidence: 99%

The Role of Anti(myco)bacterial Interventions in the Management of IBD: Is There Evidence at All?

Chambrun¹,

Torres

Darfeuille‐Michaud

et al. 2012

Dig Dis

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Background/Aims: 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. Conclusion: 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.

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“…Children with Crohn's disease often suffer delayed development as a consequence of malnutrition (11). Further, side-effects of all drugs, used in the course of therapy, must be considered (1,3,4,5,6,7,8,10,18,19,21,22).…”

Section: Introductionmentioning

confidence: 99%