The role of antibiotics in inflammatory bowel disease

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Annals of Gastroenterology
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The role of antibiotics in inflammatory bowel disease (EN)

Triantafillidis, J.K.
Triantafillidis, Aikaterini

Antibiotics are the mainstay of therapy for patients with Crohn's disease who present with localized peritonitis due to a microperforation and bacterial overgrowth secondary to chronic strictures. They are essential adjuncts to drainage therapy for Crohn's disease-associated abscesses and for perineal disease. Antibiotics have a role as primary therapy in active uncomplicated CD. The efficacy of their response must be considered in well-defined subsets of patients. Ciprofloxacin and metronidazole, the two most widely studied antibiotics, are effective therapy for patients with active ileocolonic and colonic disease and have been shown to reduce recurrence rates after ileocolonic resection. The benefits of these drugs are less clear for patients with uncomplicated ileal disease. Ciprofloxacin and metronidazole may also serve as an adjunct to immunomodulator therapy. In toxic patients with fulminant ulcerative colitis, with or without megacolon, antibiotics should be administered along with corticosteroids and other supporting measures. In less severely ill patients requiring hospitalization, antibiotics may be given to cover for the potential of a superimposed infection until the workup for infection, including Clostridium difficile, amoeba and salmonella is available. There may be a subset of patients with severe nontoxic colitis who respond to antibiotics, but to date controlled trials have not shown efficacy in this group. However, antibiotics should not be routinely used for mild to moderately ulcerative colitis, although a trial of ciprofloxacin is not unreasonable prior to colectomy for otherwise refractory patients. The use of rifaximin in UC seems promising but further evaluation is required. Altough further clinical trials evaluating the role of antibiotics in inflammatory bowel disease are required the available data are in favour of the widely adopted assumption that antibiotics are useful and valuable drugs in patients with either Crohn's disease or ulcerative colitis. (EN)


Αγγλική γλώσσα


Hellenic Society of Gastroenterology (EN)

Annals of Gastroenterology; Volume 21, No 1 (2008); 17-26 (EN)

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