Effect of Long‐term Tetracycline Therapy, Steroid Therapy and Colectomy in Pericholangitis Associated With Ulcerative Colitis

Abstract

SUMMARY The effect of long‐term tetracycline and steroid therapy, colectomy and biliary drainage on the clinical course, the results of liver‐function tests and hepatic histological changes in seven cases of pericholangitis and ulcerative colitis have been assessed. Tetracycline was given to six patients for periods varying from one and a half to six years in a maintenance dose of 500 mg. per day, and prednisone was given to three patients for periods of five, five and ten years respectively. None of the forms of treatment used had an effect on the clinical course, the pathological changes or the results of liver‐function tests in this disease. Attacks of cholestasis and cholangitis occurred with equal frequency and severity both before and after therapy. The hypercholesterolæmia and raised serum alkaline phosphatase level persisted, and the expected progression from acute to subacute to chronic pericholangitis, and in some cases to post‐necrotic cirrhosis, occurred in spite of therapy.

Primary sclerosing cholangitis

“…Alternative agents are amoxicillin or trimethoprim/sulfamethoxazole. Tetracycline was ineffective in one small study in PSC [8]. However, there have been no randomized prospective trials that have critically evaluated antibiotics in patients with PSC.…”

Randomised clinical trial: vancomycin or metronidazole in patients with primary sclerosing cholangitis ‐ a pilot study

“…reactive airways disease, after which incidental improvement of PSC was noted). 28,29,[32][33][34][35][36] Given the evidence supporting the PSC microbiota hypothesis yet the limited studies investigating the potential therapeutic effects of antibiotics, we conducted a randomised, double-blind pilot study of oral vancomycin or metronidazole as a treatment for patients with PSC. We chose these agents based on prior experience and evidence of seemingly greater therapeutic response.…”

Metronidazole and ursodeoxycholic acid for primary sclerosing cholangitis: A randomized placebo-controlled trial

“…14 Only one small, uncontrolled long-term study using antibiotics in the treatment of PSC has been published so far. 15 The study compared tetracycline, steroid therapy, and colectomy in the management of PSC, demonstrating that none of the strategies had a beneficial effect on the clinical course of the disease.…”