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

Abstract

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.

Colitis susceptibility in mice with reactive oxygen species deficiency is mediated by mucus barrier and immune defense defects

“…Even more effective was antibiotic treatment. CGD patients are often placed on antimicrobial prophylaxis, and non-absorbable antibiotics were also beneficial in a cohort of pediatric IBD patients, [42][43][44] suggesting that reducing certain phyla or the overall bacterial load might be a promising treatment.…”

Impact of Microbial Metabolites on Microbiota–Gut–Brain Axis in Inflammatory Bowel Disease

“…Single antibiotics have some benefit for CD colitis treatment as well as septic complications, such as abscesses and fistulae, and in preventing postoperative recurrence [341,342]. In addition, the role of oral vancomycin and gentamicin in very early-onset IBD has given interesting preliminary results [343]. Broad antibiotic combinations may ameliorate the outcomes, although long-term efficacy may be reduced by development of adverse events caused by long-lasting changes in microbiota composition and the emergence of antibiotic resistance [60].…”

Antibiotics in inflammatory bowel diseases: do we know what we’re doing?

“…A recently published caseseries of infants with VEO-IBD with poor response to previous medications showed a dramatic response to oral vancomycin and gentamicin in four of the five patients, including normalization of fecal calprotectin. Sustained immunosuppressant-free remission was maintained in 3 of the patients (143). However it remains unclear if the effect of antibiotics is due to actions on one particular bacterial species, altering the composition of the microbiome, or possibly treating secondary infections which exacerbate disease (34).…”