(b) Case series and reports of antibacterial treatment in primary sclerosing cholangitis
| Drug (reference) | Year | n | Antibiotic dose | Months of therapy | Change after therapy | ||
|---|---|---|---|---|---|---|---|
| ALK | AST | ALT | |||||
| Tetracycline [36]* | 1959 | 5 | 500 mg/day | 1–10 | −45% | −60% | −45% |
| Tetracycline [27]† | 1965 | 5 | 500 mg/day | 48 (mean) | −21% | NA | NA |
| Metronidazole [37] | 1983 | 1 | 800 mg/day | 0.25 | NA‡‡ | NA‡‡ | NA‡‡ |
| Sulfasalazine (+UDCA) [38]†† | 1998 | 2‡ | — | 30 and 45 |
−79% −35% |
−38% −87% |
−70% −95% |
| Vancomycin [39] | 1998 | 3‡ | 375–1000 mg/day | 9 (mean) | NA | NA | −89% |
| Sulfasalazine (+UDCA) [40] | 2002 | 1 | 50 mg/kg/day | 37 | NA | NA | −92% |
| Sulfasalazine [41] | 2006 | 1 | 2–4.5 g/day | 24 | −74% | NA | −84% |
| Azithromycin (+UDCA) [42] | 2007 | 1 | 500 mg/day, 3 days/week | 5 | −72% | −31% | −33% |
| Vancomycin [43] | 2008 | 14‡ | 50 mg/kg/day | 54 ± 43 | NA | NA | −78% |
Key: ALK: alkaline phosphatase, AST: aspartate aminotransferase; ALT: alanine aminotransferase, GGT: γ-glutamyl transpeptidase; tid: three times a day; qid: four times a day; UDCA: ursodeoxycholic acid.
Months of treatment and followup are absolute unless otherwise indicated.
*Includes one patient who also received prednisone but was not separable from the other 4 patients.
†Does not include two patients who received prednisone.
††Does not include a third patient who also received prednisolone and mizoribine.
‡Pediatric patients.
‡‡Original case report states there was dramatic improvement in patient's condition, including defervescence, return of appetite, and reduction of serum bilirubin, and after 2 weeks, becoming completely asymptomatic. Six months later, patient returned with clinical worsening, which again responded to metronidazole.