Long‐term Treatment of Primary Sclerosing Cholangitis in Children With Oral Vancomycin: An Immunomodulating Antibiotic

Davies, Yinka; Cox, Kathleen M.; Abdullah, Bisher; Safta, Anca; Terry, Annie; Cox, Kenneth L.

doi:10.1097/mpg.0b013e31816fee95

Cited by 154 publications

(117 citation statements)

References 29 publications

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“…7 A few studies have suggested a clinical benefit of treatment with vancomycin in PSC children with IBD, 23 and especially those without cirrhosis. 24 No patients in our series were taking this antibiotic.…”

Section: Treatment Clinical Course and Prognosismentioning

confidence: 99%

Clinical course and prognosis of pediatric-onset primary sclerosing cholangitis

Tenca

Färkkilä

Arola

et al. 2016

United European Gastroenterology Journal

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Background: The natural history of pediatric-onset primary sclerosing cholangitis (PSC) and overlap with autoimmune hepatitis (PSC/AIH) is poorly known. Objective: The aim of this study was to evaluate the clinical outcome of patients with pediatric-onset disease in a tertiary referral center. Methods: We traced 33 patients (median age at diagnosis 16 years), with PSC or PSC/AIH in cholangiography and liver histology diagnosed between December 1993 and 2011, at Helsinki University Hospital. Diagnostic procedures and long-term follow-up were reassessed until the end of December 2013. Results: PSC was confirmed in all 33 patients; 19 of them had an overlap with AIH. At diagnosis, three of 33 had cirrhosis. Inflammatory bowel disease (IBD) was associated in 76% of the patients, mostly ulcerative colitis (70%); treatment of IBD being a minor determinant of the clinical outcome of liver disease. In the last follow-up (median nine years), all patients were alive, and no malignancy occurred. Most patients (91%) were on ursodeoxycholic acid and 12 PSC/AIH patients on immunosuppression. Endoscopic retrograde cholangiography during follow-up showed a progression of intra-hepatic disease in 12 patients (36%). Four patients (12%) had undergone liver transplantation, and one was listed; no recurrence of the disease in the graft was seen. Conclusion:The clinical course and outcome of pediatric-onset PSC and PSC/AIH seem to be favourable in the majority of patients until early adulthood. In about one-third of patients, however, PSC is progressive, challenging the current treatment guidelines and warranting further studies on disease pathogenesis.

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Section: Treatment Clinical Course and Prognosismentioning

confidence: 99%

Clinical course and prognosis of pediatric-onset primary sclerosing cholangitis

Tenca

Färkkilä

Arola

et al. 2016

United European Gastroenterology Journal

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“…In addition, when vancomycin treatment was discontinued, there was recurrence of clinical symptoms and an increase in liver enzymes in several patients and re-treatment again resulted in normalisation of liver enzymes. 27 Most recently, in a pilot study by Silveira et al, 16 patients with PSC were treated with minocycline for one year; although a substantial proportion of patients withdrew from the study due to AEs, those who continued treatment were found to experience a significant reduction in ALK. 39 Although the use of antibiotics in PSC seems logical and promising based on the clinical experience described above, there is very little data on humans supporting their role in the pathophysiology of this disease.…”

mentioning

confidence: 99%

“…[27][28][29][30] Aminotransferase values are independently associated with prognosis and are a component of the Months of treatment and follow-up are absolute unless otherwise indicated. Mayo PSC risk score, and ALK values have been recently associated with prognosis, 31 thus making these two readily measured liver biochemistries important end points in studies of PSC.…”

mentioning

confidence: 99%

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

Tabibian

Weeding

Jorgensen

et al. 2013

Aliment Pharmacol Ther

226

171

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“…One underpowered, double-blind, controlled study of oral vancomycin as add-on treatment to intravenous steroids in 33 adult patients with acute severe colitis reported a lower numerical rate of short-term colectomy in the vancomycin arm (11%) vs. placebo (47%; p = 0.057) [8]. In a few case series and one small controlled study, vancomycin has been found to improve PSC [4,5,8,9,10]. Two of these studies were in children and reported that the IBD-related symptoms also improved in all patients; those patients who underwent repeat colonoscopy showed endoscopic resolution or improvement [4,5].…”

Section: Discussionmentioning

confidence: 99%

Oral Vancomycin and Gentamicin for Treatment of Very Early Onset Inflammatory Bowel Disease

Lev-Tzion

Ledder²,

Shteyer³

et al. 2017

Digestion

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Background: The pathogenesis of inflammatory bowel disease (IBD) is complex and involves the contribution of genetic and environmental factors. Many patients with very early onset IBD are difficult to treat. The current antibiotic medication that targets gram-negative and anaerobic bacteria provides only moderate efficacy in subsets of patients with IBD. Methods: We report a case series of 5 children with a mean age of 1.6 years (range 6 months to 2.7 years) during IBD onset, who were previously refractory to standard treatments and who received oral vancomycin with or without gentamicin. Results: Four out of 5 children demonstrated substantial therapeutic effect, and the effect was sustained in 3 children over a follow-up period of 12-33 months. Conclusion: Our findings are consistent with model systems and suggest that randomized trials are required to establish whether a change in therapeutic paradigm, that is, targeting gram-positive bacteria with nonabsorbable antibiotics, may have therapeutic benefits.

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Long‐term Treatment of Primary Sclerosing Cholangitis in Children With Oral Vancomycin: An Immunomodulating Antibiotic

Cited by 154 publications

References 29 publications

Clinical course and prognosis of pediatric-onset primary sclerosing cholangitis

Clinical course and prognosis of pediatric-onset primary sclerosing cholangitis

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

Oral Vancomycin and Gentamicin for Treatment of Very Early Onset Inflammatory Bowel Disease

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