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

Abstract

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.

Changes in the composition of intestinal fungi and their role in mice with dextran sulfate sodium-induced colitis

“…Unexpectedly, fungi-depleted mice exhibited aggravated colitis manifested by increased weight loss, histological score, and proinflammatory cytokine production and decreased colon length. However, intestinal inflammation was alleviated in bacteria-depleted mice, consistent with previous studies 32 . Therefore, we hypothesized that bacteria are the major driving force in acute enteric inflammation.…”

“…IBD patients and animal models commonly have an abundance of gut bacteria in the inflamed mucosa, and antibiotics effectively attenuate intestinal inflammation 31 32 . We tested whether colitis can be mitigated by eliminating gut fungi, which also gather in the inflamed mucosa, by evaluating the severity of acute DSS-colitis in bacteria-depleted and fungi-depleted mice.…”

Management of Paediatric Ulcerative Colitis, Part 1

“…Antibiotic treatment is considered first-line treatment for pouchitis. However, only small placebo-controlled trials have been conducted to support this practice and none in children (365,366). Ciprofloxacin may be slightly more effective than metronidazole, with fewer adverse Copyright © ESPGHAN and NASPGHAN.…”

The Fungal Mycobiome and Its Interaction with Gut Bacteria in the Host

“…This suggests that in IBD, the myco- and microbiome have a mutual influence on each other. Pointing to the role of the bacteria and microbial dysbiosis in IBD, a study that reviewed randomised controlled trials found significant effects of broad-spectrum antibiotics in the treatment of active CD and active UC [51]. Taken together, these studies suggest that bacterial dysbiosis in the gut, and the richness and diversity of the mycobiome, are important in IBD susceptibility.…”