Adjunct antibiotic combination therapy for steroid-refractory or -dependent ulcerative colitis: an open-label multicentre study

Background We previously demonstrated that antibiotic combination therapy is effective for induction and maintenance of ulcerative colitis (UC) remission. Aim To assess whether antibiotic combination therapy is effective for active UC refractory to or dependent on steroids in a multicentre, open-label trial. Methods We enrolled 30 patients with steroid-refractory and 64 with steroid-dependent active UC. These patients received three-times-daily by mouth amoxicillin 500mg, tetracycline 500mg and metronidazole 250mg, for two weeks, as well as conventional treatment. Symptom assessment and colonoscopic evaluation were performed before enrolment and at 3 and 12months after treatment completion. Clinical response was defined as a Lichtiger symptom score decrease in >= 3 points and clinical remission as a score <= 4. Results Nineteen of the 30 steroid-refractory (63.3%) and 47 of the 64 steroid-dependent (73.4%) patients showed a clinical response within 2weeks. At 3 and 12months, 60% and 66.6% of steroid-refractory patients, and 56.3% and 51.6% of steroid-dependent patients, respectively, achieved clinical remission. In the steroid-dependent group, 39 of the 64 patients (60.9%) were able to stop steroid therapy and remained in remission for 3months. Three (10%) steroid-refractory and four (6.3%) steroid-dependent patients underwent colectomy. Conclusions This multicentre, long-term follow-up study suggests 2week antibiotic combination therapy to be effective and safe in patients with active UC refractory to or dependent on steroids.