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Antibiotic combination therapy for steroid-refractory or -dependent ulcerative colitis

The latest publication of the Alimentary Pharmacology & Therapeutics reports that adjunct antibiotic combination therapy is effective for steroid-refractory or -dependent ulcerative colitis.

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Dr Kato and colleagues from Japan previously demonstrated that antibiotic combination therapy is effective for induction and maintenance of ulcerative colitis (UC) remission.

The research team assessed whether antibiotic combination therapy is effective for active ulcerative colitis refractory to or dependent on steroids in a multicenter, open-label trial.

The researchers enrolled 30 patients with steroid-refractory, and 64 with steroid-dependent active ulcerative colitis.

73% of steroid-dependent patients showed a clinical response within 2 weeks 
Alimentary Pharmacology & Therapeutics

These patients received 3-times-daily by mouth amoxicillin 500 mg, tetracycline 500 mg and metronidazole 250 mg, for 2 weeks, as well as conventional treatment.

Symptom assessment and colonoscopic evaluation were performed before enrolment, and at 3 and 12 months after treatment completion.

Clinical response was defined as a Lichtiger symptom score decrease in ≥3 points and clinical remission as a score ≤4.

The researchers found that 63% of steroid-refractory, and 73% of steroid-dependent patients showed a clinical response within 2 weeks.

At 3 and 12 months, 60% and 67% of steroid-refractory patients, and 56% and 52% of steroid-dependent patients, respectively, achieved clinical remission.

In the steroid-dependent group, 61% of patients were able to stop steroid therapy, and remained in remission for 3 months.

The team noted that 10% of steroid-refractory, and 6% of steroid-dependent patients underwent colectomy.

Dr Kato's team concludes, "This multicenter, long-term follow-up study suggests 2 week antibiotic combination therapy to be effective, and safe in patients with active ulcerative colitis refractory to or dependent on steroids."

Aliment Pharmacol Ther 2014: 39(9): 949–956
11 April 2014

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