Table 2.
Antibiotics for IBD (Randomized trials)
| Author, year | Disease activity |
Case /Control |
Base therapy | Agent (s) | Route | Therapy duration |
Outcomes, therapy vs control | PMID |
|---|---|---|---|---|---|---|---|---|
| Ulcerative colitis | ||||||||
| Dickinson, 1985 | active | 18/15 | Steroid | Vancomycin | oral | 7 d | NS | 3910524 |
| Chapman, 1986 | active | 19/20 | Steroid | Metronidazole | i.v. | 5 d | NS | 3536677 |
| Burke, 1990 | active | 42/42 | Steroid | Tobramycin | oral | 7 d | Improve clinical and histological score, 74% vs 43% | 2104079 |
| Mantzaris, 1994 | active | 19/20 | Steroid | Metronidazole + Tobramycin | i.v. | 10 d | NS | 8273796 |
| Mantzaris, 1997 | active | 34/36 | Olsalazine, steroid (oral/enema) | Ciprofloxacin | oral | 14 d | NS | 9068468 |
| Casellas, 1998 | active | 19/11 | Steroid | Amoxicillin | oral | 5 d | Improve luminal IL-8 and other inflammatory mediaters | 9552221 |
| Turunen, 1998 | active | 38/45 | Steroid, 5-ASA, sulfa | Ciprofloxacin | oral | 6 m | Improve endoscopic and histologic scores at 3 mo, but not at 6, 12mo. | 9797360 |
| Gionchetti, 1999 | active | 14/12 | Steroid | Rifaximin | oral | 10 d | Improve clinical, endoscopic scores, 64% vs 42% | 10389700 |
| Mantzaris, 2001 | active | 29/26 | Steroid | Ciprofloxacin | i.v. | 10 d | NS | 11521989 |
| Ohkusa, 2005 | active | 10/10 | Steroid, 5-ASA, probiotics | Amoxicillin + Tetracycline + Metronidazole | oral | 14 d | Improve clinical, endoscopic, and histological scores | 16334443 |
| Ohkusa, 2010 | active | 105/105 | Steroid, 5-ASA, immunosuppressant, sulfa | Amoxicillin + Tetracycline + Metronidazole | oral | 14 d | Improve clinical, endoscopic, and histological scores | 20216533 |
| Turner, 2018 | active | 16/12 | Steroid (i.v.) | Amoxicillin + Vancomycin + Metronidazole + Doxycyclin/Ciprofloxacin | 5 d | Improve clinical score | Abst (a) | |
| Pouchitis | ||||||||
| Madden, 1994 | active | 11/11 | Metronidazole | oral | 2 w | Improve stool frequency (73% vs 0%) | 8200250 | |
| Shen, 2001 | active | 7/9 | Ciprofloxacin vs Metronidazole | oral | 2 w | Both improve clinical and endoscopic scores. Efficacy: cipro>metro | 11720319 | |
| Isaacs, 2007 | active | 8/9 | 5-ASA, probiotics, NSAIDs | Rifaximin | oral | 4 w | Improve remission rate (25% vs 0%) | 17567869 |
| Crohn’s disease | ||||||||
| Blichfeldt, 1978 | active | 20/20 | Sulfa, steroid | Metronidazole | oral | 2 m | NS | 345410 |
| Kelleher, 1982 | inactive | 10/10 | Clofazimine | oral | 6 m | Improve relapse rate (0% vs 30%) | Abst (b) | |
| Ambrose, 1985 | active | 18/16/21/17 | Steroid, 5-ASA, AZA | Metronidazole vs Cotrimoxazole vs Combined vs placebo | oral | 4 w | At 2w, improve symptoms. At 4w, NS | 3882364 |
| Dickinson, 1985 | active | 4/3 | Steroid | Vancomycin | oral | 7 d | NS | 3910524 |
| Sutherland, 1991 | active | 33/30/36 | Metronidazole low dose vs high dose vs placebo | oral | 16 w | Improve clinical score Efficacy: high dose > low dose | 1916494 | |
| Afdhal, 1991 | active | 25/24 | Steroid | Clofazimine | oral | 3 m | NS | 2007362 |
| Afdhal, 1991 | inactive | 16/12 | Clofazimine | oral | 12 m | NS (reduce clinical score) | 2007362 | |
| Prantera, 1994 | inactive | 19/17 | Steroid tapering | Clofazimine + Rifampin + Ethambutol + Dapsone | oral | 9 m | Improve relapse rate | 8147352 |
| Graham, 1995 | active | 7/8 | Clarithromycin | oral | 3 m | Improve remission rate (71% vs 13%) | Abst (c) | |
| Goodgame, 2001 | active | 9/9 | Ethambutol + Clarithromycin | oral | 3 m | NS | 11736715 | |
| Arnold, 2002 | active | 25/12 | Ciprofloxacin | oral | 1 m | Improve clinical score | 11837933 | |
| Steinhart, 2002 | active | 66/64 | Ciprofloxacin + Metronidazole | oral | 8 w | NS | 12105831 | |
| West, 2004 | fistula | 11/13 | Anti-TNF-α | Ciprofloxacin | oral | 12 w | NS (improve fistula 73% vs 39%) | 15606395 |
| Rutgeerts, 2005 | inactive | 38/40 | Steroid | Ornidazole | oral | 54 w | Improve recurrence rate (8% vs 38%) | 15825069 |
| Prantera, 2006 | active | 25/27/27 | Immunosuppressant, 5-ASA | Rifaximin o.d. vs b.d vs placebo | oral | 12 w | NS (improve remission rate) Efficacy: o.d.<b.d. | 16611272 |
| Selby, 2007 | active | 102/111 | Steroid | Clarithromycin + Rifabutin +Clofazimine | oral | 16 w | Improve remission rate (66% vs 50%) | 17570206 |
| Leiper, 2008 | active | 12/10 | Steroid, 5-ASA, AZA | Clarithromycin | oral | 3 m | At 1 m, improve clinical scores At 3m, NS | 18315579 |
| Thia, 2009 | fistula | 9/2/7 | Immunosuppressant, steroid | Ciprofloxacin vs Metronidazole vs placebo | oral | 10 w | NS (remission: 30% vs 0% vs 13%) | 18668682 |
| Maeda, 2010 | fistula | 33/41 | Steroid, 5-ASA, immunosuppressant, antibiotics, anti-TNF-α | Metronidazole | oral | 4 w | Improve clinical score and perianal discharge and pain | 20632322 |
| Prantera, 2012 | active | 104/98/99/101 | Steroid, 5-ASA, immunosuppressant, antibiotics, anti-TNF-α | Rifaximin-EIR low vs mid vs high dose vs placebo | oral | 12 w | Improve remission rate by mid-dose 800mg/d (62% vs 43% placebo) | 22155172 |
| Herfarth, 2013 | inactive | 17/16 | Steroid, 5-ASA, immunosuppressant | Ciprofroxacin | oral | 6 m | NS | 23511031 |
| Jigaranu, 2014 | active | 83/83 | 5-ASA, AZA, anti-TNF-α | Rifaximin | oral | 12 w | Improve remission rate (100% vs 84%) | 24969283 |
| Levine, 2019 | active | 35/38 child | Azithromycin+Metronidazole vs Metronidazole | oral | 8 w | Improve remission rate (66% vs 39%) | 29420227 | |
IBD: inflammatory bowel disease, PMID: PubMed identifier, NS: no statistically significant difference in disease activity, 5-ASA: 5-aminosalicylic acid, sulfa: salazosulfapyridine, AZA; azathioprine, NSAID: nonsteroidal antiinflammator drug, o.d.: once a day, b.d. twice a day, EIR: extended intestinal release. Abst (a): JCC 2018,12,S366, Abst (b): Gut 1982,23,A449, Abst (c): Gastroenterology 1995,108,A826