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P391 Antibiotics in pediatric Inflammatory Bowel Diseases: a systematic review

Verburgt, C.(1,2);Heutink, W.P.(3);Kuilboer, L.I.M.(1);Dickmann, J.D.(1);van Etten-Jamaludin, F.S.(4);Benninga, M.A.(1);de Jonge, W.J.(2,5);Van Limbergen, J.E.(1,2,6);Tabbers, M.M.(1);

(1)Emma Children’s Hospital- Amsterdam University Medical Centers, Department of Pediatric Gastroenterology and Nutrition, Amsterdam, The Netherlands;(2)Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands;(3)Wilhelmina Children’s Hospital- University Medical Center Utrecht, Department of Pediatrics, Utrecht, The Netherlands;(4)Amsterdam University Medical Centers, Research support- Medical library, Amsterdam, The Netherlands;(5)University of Bonn, Department of Surgery, Bonn, Germany;(6)Dalhousie University, Department of Pediatrics, Halifax, Canada

Background

Dysbiosis is the central concept in the current thinking regarding IBD pathogenesis. Current available therapies in pediatric Inflammatory Bowel Disease (IBD) focus on targeting the immune system by suppressing the immune response and often fail to sustain long term remission. Antibiotics directly target bacteria but are underrepresented in current (pediatric and adult) IBD treatment guidelines. We aimed to describe available evidence concerning the use of antibiotics in the treatment of pediatric IBD.  

Methods

We systematically assessed efficacy and safety of antibiotics in pediatric IBD. CENTRAL, EMBASE (Ovid) and Medline (Pubmed) were searched for Randomized Controlled Trials (RCTs). Quality assessment of included articles was conducted with the Cochrane risk-of-bias tool.

Results

Two RCT’s (n=101, 4.4-18 years, 43% male) were included. Both studies had overall low risk of bias. In mild-to-moderate Crohn’s disease, azithromycin+metronidazole (AZ+MET) (n=35) compared to metronidazole (MET) alone (n=38) did not induce a significantly different response (PCDAI drop ≥12.5 points or remission) (p=0.07).  For induction of remission (PCDAI≤10), AZ+MET was more effective than MET (p=0.025). In Acute Severe Colitis, the mean 5-day PUCAI was significantly lower in the antibiotic (vancomycin, amoxicillin, metronidazole, doxycycline)+intravenous corticosteroids (IVCS) group (n=16) compared to IVCS (n=12) alone (p=0.037), whereas remission (PUCAI<10) did not differ (p=0.61). No significant drug-related adverse events were reported.  

Conclusion

Our results highlight the lack of evidence in pediatric IBD. More evidence is needed to assess if implementation in daily practice is necessary.

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