Combination of oral antibiotics may be effective in severe pediatric ulcerative colitis: A preliminary report

Background: The results of previous studies on the effectiveness of antibiotics in ulcerative colitis (UC) seem more effective when used orally. In this retrospective, multicenter study, we aimed to report our experience of using a combination of 3-4 antibiotics in children with moderate-severe refractory UC and IBD-unclassified including metronidazole, amoxicillin, doxycycline, and if during hospital admission, also vancomycin (MADoV). Methods: All children treated during 2013 with the antibiotic cocktail for 2-3 weeks in an attempt to alleviate inflammation in refractory colitis were included. Doxycycline was substituted with oral gentamycin or ciprofloxacin in children younger than 8 years or when an allergy was known to one of the drugs. Children were assessed using the PUCAI and CRP weekly for 3 weeks. Results: All 15 included children had moderate to severe disease with refractory disease course to multiple immunosuppressants (mean age 13.6 +/- 5.1 years, median disease duration 2 (IQR 0.8-3.2) years, 11 females (73%), and 13 (87%) extensive disease; 14 (93%) were corticosteroid-dependent or resistant, and 12 (80%) refractory to anti-TNF therapy). The cocktail was definitely effective in 7 of the 15 included children (47%) who entered complete clinical remission (PUCAI < 10) without additional interventions. Questionable or partial short-term response was noted in another 3 (20%), totaling 67% of patients. Conclusion: The use of oral wide-spectrum antibiotic cocktail in pediatric UC seems promising in half of patients, refractory to other salvage therapy. A pediatric randomized controlled trial to assess this intervention is underway. (C) 2014 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.