tetracycline and Colitis--Ulcerative

The aim of this study was to critically assess all available evidence suggesting an association between antibiotic exposure and new onset of inflammatory bowel disease (IBD).. This systematic review was conducted according to the PRISMA statement and eligible studies were identified through search of PubMed, Embase and the Cochrane Library. Data on patient demographics, antibiotic exposure and confounding factors were analyzed. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of eligible studies.. A total of 15 observational studies (10 case control and five cohort) including 8748 patients diagnosed with IBD were systematically reviewed. Antibiotic exposure was mostly associated with Crohn's disease but not with ulcerative colitis. In particular, penicillin's, cephalosporins, metronidazole and fluoroquinolones were most commonly associated with the onset of Crohn's disease. The impact of tetracycline-family antibiotics on the pathogenesis of IBD was not clear.. There may be an association between antibiotic exposure and the development of IBD; especially Crohn's disease. Even though, clinicians should be cautious when prescribing certain antibiotic regimens to patients with a strong family history of IBD, it should be emphasized that available data are not granular enough to reach any definitive conclusions.

Topics: Anti-Bacterial Agents; Colitis, Ulcerative; Crohn Disease; Fluoroquinolones; Humans; Metronidazole; Penicillins; Risk; Tetracycline

Topics: Adolescent; Adult; Aged; Cholangiography; Cholangitis; Colitis, Ulcerative; Diagnosis, Differential; Drainage; Female; Hepatitis B Antigens; Humans; Liver; Male; Middle Aged; Pancreatitis; Phlebitis; Portal Vein; Sclerosis; Shwartzman Phenomenon; Tetracycline

Previous work has demonstrated that intestinal bacteria, such as Fusobacterium varium (F. varium), contribute to the clinical activity in ulcerative colitis (UC); thus, an antibiotic combination therapy (amoxicillin, tetracycline, and metronidazole (ATM)) against F. varium can induce and maintain UC remission. Therefore, we investigated whether ATM therapy induces a long-term alteration of intestinal microbiota in patients with UC. Patients with UC were enrolled in a multicenter, randomized, double-blind, placebo-controlled study. Biopsy samples at the beginning of the trial and again at 3 months after treatment completion were randomly obtained from 20 patients. The terminal restriction fragment length polymorphism (T-RFLP) in mucosa-associated bacterial components was examined to assess the alteration of the intestinal microbiota. Profile changes of T-RFLP in mucosa-associated bacterial components were found in 10 of 12 patients in the treatment group and in none of 8 in the placebo group. Dice similarity coefficients using the unweighted pair group method with arithmetic averages (Dice-UPGMA) confirmed that the similarity of mucosal microbiota from the descending colon was significantly decreased after the ATM therapy, and this change was maintained for at least 3 months. Moreover, at 3 months after treatment completion, the F. varium/β-actin ratio, examined by real-time PCR using nested PCR products from biopsy samples, was reduced less than 40% in 8 of 12 treated patients, which was higher, but not significantly, than in 4 of 8 patients in the placebo group. Together, these results suggest that ATM therapy induces long-term alterations in the intestinal microbiota of patients with UC, which may be associated, at least in part, with clinical effects of the therapy.

Topics: Actins; Adolescent; Adult; Aged; Amoxicillin; Anti-Bacterial Agents; Colitis, Ulcerative; Double-Blind Method; Drug Therapy, Combination; Female; Fusobacterium; Fusobacterium Infections; Humans; Intestinal Mucosa; Male; Metronidazole; Microbiota; Middle Aged; Tetracycline

We previously demonstrated that antibiotic combination therapy is effective for induction and maintenance of ulcerative colitis (UC) remission.. To assess whether antibiotic combination therapy is effective for active UC refractory to or dependent on steroids in a multicentre, open-label trial.. We enrolled 30 patients with steroid-refractory and 64 with steroid-dependent active UC. These patients received three-times-daily by mouth amoxicillin 500 mg, tetracycline 500 mg and metronidazole 250 mg, for two 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.. Nineteen of the 30 steroid-refractory (63.3%) and 47 of the 64 steroid-dependent (73.4%) patients showed a clinical response within 2 weeks. At 3 and 12 months, 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 3 months. Three (10%) steroid-refractory and four (6.3%) steroid-dependent patients underwent colectomy.. This multicentre, long-term follow-up study suggests 2 week antibiotic combination therapy to be effective and safe in patients with active UC refractory to or dependent on steroids.

Topics: Adolescent; Adult; Aged; Amoxicillin; Anti-Bacterial Agents; Colectomy; Colitis, Ulcerative; Colonoscopy; Combined Modality Therapy; Drug Therapy, Combination; Female; Follow-Up Studies; Glucocorticoids; Humans; Male; Metronidazole; Middle Aged; Severity of Illness Index; Tetracycline; Time Factors; Treatment Outcome; Young Adult

Immunosuppressive drugs are recommended for use as replacements of steroid therapy in sustaining remission of steroid-dependent ulcerative colitis (UC). However, discontinuation of these therapeutic agents leads to a high relapse, and their long-term administration has not been proven safe. A newly introduced antibiotic combination therapy led to improvement and remission of active UC. The aim of this study is to examine whether this new therapy can replace immunosuppressive agents and allow discontinuation of steroids in steroid-dependent UC remission.. 48 patients with steroid-dependent UC were recruited for a 2-week treatment with amoxicillin, tetracycline, and metronidazole (ATM). Examination of clinical symptoms, endoscopy, and histological evaluation were performed before and 6 and 12 months after treatment.. The proportion of patients who showed clinical improvement at 6 and 12 months after treatment was 54.2% (26/48) and 75.0% (36/48), respectively. The rate of clinical remission at 6 and 12 months was 31.3% (15/48) and 37.5% (18/48), respectively. Steroid withdrawal was attained in 64.6% (31/48) and 70.8% (34/48) of patients at 6 and 12 months, respectively. Endoscopic improvement was detected in 56.3% (27/48), and histological improvement was detected in 52.1% (25/48) at the final observation point for each patient.. The triple antibiotic therapy resulted in improvement, remission, and steroid withdrawal in steroid-dependent UC patients.

Topics: Adolescent; Adult; Aged; Amoxicillin; Anti-Bacterial Agents; Azathioprine; Colitis, Ulcerative; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Male; Metronidazole; Middle Aged; Remission Induction; Tetracycline; Young Adult

Fusobacterium varium may contribute to ulcerative colitis (UC). We conducted a double-blind placebo-controlled multicenter trial to determine whether antibiotic combination therapy induces and/or maintains remission of active UC.. Patients with chronic mild-to-severe relapsing UC were randomly assigned to oral amoxicillin 1500 mg/day, tetracycline 1500 mg/day, and metronidazole 750 mg/day, vs. placebo, for 2 weeks, and then followed up. The primary study end point was clinical response (Mayo score at 3 months after treatment completion) and secondary end points were clinical and endoscopic score improvements at 12 months. Anti-F. varium antibodies were measured by enzyme-linked immunosorbent assay.. Treatment and placebo groups each had 105 subjects. At the primary end point, response rates were significantly greater with antibiotics than with placebo (44.8 vs. 22.8%, P=0.0011). Endoscopic scores significantly improved at 3 months (P=0.002 vs. placebo). Remission rates were 19.0% (antibiotics) vs. 15.8% (placebo) at 3 months (P=0.59). At the secondary end point, response rates were significantly greater with antibiotics than with placebo (49.5 vs. 21.8%, respectively, P<0.0001). Endoscopic scores were significantly improved at 12 months after antibiotic treatment (P=0.002 vs. placebo). Remission rates had improved to 26.7% with antibiotics vs. 14.9% for placebo, at 12 months (P=0.041). F. varium antibody titers decreased in responders but not in nonresponders, and more in the antibiotic than in the placebo group. More pretreatment steroid-dependent UC patients discontinued corticosteroids after treatment completion (6 months: 28.6 vs. 11.8%, respectively, P=0.046; 9 months: 34.7 vs. 13.7%, respectively, P=0.019; and 12 months: 34.7 vs. 13.7%, respectively, P=0.019). These effects were greater in the subanalysis of the active group (Mayo scores of 6-12) than in that of total cases (0-12). No serious drug-related toxicities occurred.. The 2-week triple antibiotic therapy produced improvement, remission, and steroid withdrawal in active UC more effectively than a placebo.

Topics: Administration, Oral; Adrenal Cortex Hormones; Adult; Amoxicillin; Colitis, Ulcerative; Double-Blind Method; Drug Therapy, Combination; Endoscopy, Gastrointestinal; Enzyme-Linked Immunosorbent Assay; Female; Fusobacterium Infections; Humans; Male; Metronidazole; Placebos; Statistics, Nonparametric; Tetracycline; Treatment Outcome

We previously demonstrated that antibiotic combination therapy is effective for induction and maintenance of ulcerative colitis (UC) remission. Herein, we assessed whether antibiotic combination therapy is effective for active UC, including cases with steroid refractory or dependent disease.. We enrolled 25 patients with active UC including 17 steroid-dependent or refractory cases. These patients received amoxicillin 500 mg t.i.d., tetracycline 500 mg t.i.d. and metronidazole 250 mg t.i.d. for 2 weeks as well as conventional treatment. Seven colonic segments from the appendiceal region to the rectum were scored for endoscopic activity and histology. Clinical activity indexes (CAI) were also determined.. At 3 and 12 months after antibiotic treatment, CAI and endoscopic score were significantly decreased as compared to those before treatment (P < 0.001 and P < 0.05, P < 0.01, respectively). Histological scores were also significantly decreased at 12 months as compared to before treatment (P < 0.01). The clinical response rates in steroid-dependent patients were 60% and 73.3% at 3 and 12 months, respectively, while being 50% at 12 months in steroid-refractory patients. Among the 17 steroid-dependent or refractory patients, 12 (70.6%) were able to discontinue steroid therapy at 12 months. No serious drug-related toxicities were observed during the trial.. This long-term follow-up study suggests 2-week antibiotic combination therapy to be effective and safe in patients with active UC including those with steroid-refractory or dependent disease.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Biomarkers; Colitis, Ulcerative; Colon; Colonoscopy; Drug Therapy, Combination; Female; Humans; Male; Medication Adherence; Metronidazole; Middle Aged; Recurrence; Remission Induction; Severity of Illness Index; Steroids; Tetracycline; Time Factors; Treatment Outcome; Young Adult

We proposed that Fusobacterium varium is one of the causative agents in ulcerative colitis.. To examine the efficacy of antibiotic combination therapy against F. varium and to investigate the mucosa-associated bacteria before and after the therapy using a new molecular approach.. Twenty patients with ulcerative colitis were randomly assigned into the antibiotic treatment group (amoxicillin, tetracycline and metronidazole for 2 weeks) and no-antibiotics group. Clinical assessment, colonoscopic and histological evaluations were performed at 0 and 3-5 months after the treatment. DNA from mucosal bacteria was isolated from biopsy specimens. We investigated the mucosa-associated bacterial components by terminal restriction fragment length polymorphism with the restriction enzyme HhaI and MspI, and quantified the change in the number of bacteria by real-time polymerase chain reaction. Immunohistochemical detection of F. varium in biopsy specimens was also performed.. After the treatment, the clinical assessment, colonoscopic and histological scores improved in the antibiotic group compared with the control group. Three peaks of terminal restriction fragment length polymorphism decreased after treatment only in the antibiotic group. Eubacterium rectale, Dorea formicigenerans, Clostridium clostridioforme and F. varium were included in these peaks. Based on the real-time polymerase chain reaction study, only F. varium was significantly reduced after treatment. In the immunostaining, post-treatment scores in treatment group were significantly lower than that in control group.. Antibiotics combination therapy was effective for ulcerative colitis. The number of mucosa-associated F. varium significantly decreased after the treatment.

Topics: Amoxicillin; Colitis, Ulcerative; Drug Therapy, Combination; Fusobacterium; Fusobacterium Infections; Humans; Intestinal Mucosa; Metronidazole; Tetracycline

It is proposed that Fusobacterium varium might be one of the elusive pathogenic factors in ulcerative colitis (UC). Our goal was to assess whether an antibiotic combination therapy against F. varium is effective for induction and maintenance of remission of UC.. Twenty chronic, active UC patients with F. varium infection were enrolled consecutively and were randomly assigned to receive amoxicillin, tetracycline or metronidazole per os for 2 weeks (treatment group; n=10), or no antibiotics (control group; n=10). F. varium was sensitive to the antibiotics. Symptom assessment, endoscopic and histological evaluations were performed blind before enrollment at 3-5 months and 12-14 months after the treatment. Serum immunoglobulins to F. varium were measured using an enzyme-linked immunosorbent assay (ELISA). Immunohistochemical detection of F. varium in biopsy specimens was carried out using the avidin-biotin complex method.. The clinical activity, endoscopic and histological scores in the treatment group decreased significantly at 3-5 and 12-14 months after the end of treatment compared with those in the control group (p=0.001-0.036). The remission rate in the treatment group was higher than that in the control group (p=0.037). In addition, the titers of antibody to F. varium and the F. varium density in the mucosa decreased at both the short- and long-term follow-ups in the treatment group (p=0.0002-0.049). No serious drug-related toxicity was observed during the trial.. The 2-week antibiotic combination therapy against F. varium was effective and safe in patients with chronic, active ulcerative colitis in this long-term follow-up study.

Topics: Adolescent; Adult; Amoxicillin; Anti-Bacterial Agents; Colitis, Ulcerative; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Fusobacterium; Fusobacterium Infections; Humans; Male; Metronidazole; Middle Aged; Probability; Reference Values; Risk Assessment; Severity of Illness Index; Statistics, Nonparametric; Tetracycline; Treatment Outcome

Topics: Adult; Colitis, Ulcerative; Conjunctivitis; Dexamethasone; Drug Therapy, Combination; Functional Laterality; Granulomatous Disease, Chronic; Humans; Keratitis; Male; Ofloxacin; Tetracycline; Visual Acuity

Recent findings indicate that bacteria play an important role in the pathogenesis of inflammatory bowel disease (IBD). However, the exact role of bacteria in ulcerative colitis (UC) has still to be elucidated. The objective of the study was to investigate the potential differences in the intestinal microbiota between patients with UC and control subjects, using terminal restriction fragment length polymorphism (T-RFLP) analysis of the mucosa-associated microbiota from UC patients and non-IBD controls.. Nine active UC patients and 11 non-IBD controls were included in the study. Seven patients with active UC who entered into the inactive phase after antibiotic combination treatment were also classified as patients with inactive UC. Mucosa-associated microbiota was compared between non-IBD controls and UC patients using T-RFLP analysis. Microbiota in both the active and inactive phase was also analyzed in UC patients receiving antibiotic treatment.. T-RFLP patterns of mucosa-associated microbiota differed between active UC patients and non-IBD controls. Microbial compositions of active UC patients were significantly less diverse. The difference resulted from loss of commensals. From the viewpoint of disease activity before and after antibiotic combination treatment, T-RFLP patterns were also different between the active and inactive phases in the identical patients. Inactive UC patients possessed more diverse microbial compositions. No specific terminal restriction fragments were observed in UC patients.. T-RFLP analysis showed that the mucosa-associated microbiota of patients with active UC differed from that of non-IBD controls. Active UC patients possessed significantly fewer diverse microbial compositions.

Topics: Adult; Aged; Aged, 80 and over; Amoxicillin; Anti-Infective Agents; Case-Control Studies; Colitis, Ulcerative; Drug Therapy, Combination; Female; Humans; Intestinal Mucosa; Male; Metronidazole; Middle Aged; Polymorphism, Restriction Fragment Length; Severity of Illness Index; Tetracycline

Topics: Acantholysis; Adolescent; Adult; Betamethasone; Colitis, Ulcerative; Female; Ferrous Compounds; Humans; Male; Stomatitis; Sulfasalazine; Tetracycline; Ulcer

A 46-year-old man with Behçet syndrome and a long history of recurrent bouts of colitis was studied by sigmoidoscopy, barium enema x-ray film, and colon biopsy. A nonspecific colitis characterized by shallow mucosal ulcerations and submucosal mononuclear infiltration in the absence of meaningful roentgenolographic changes was seen. A histopathological comparison was made between the oral and colonic lesions. The aphthous colitis appears, therefore, to be a colonic manifestation of Behçet syndrome, differing from typical chronic nonspecific ulcerative colitis in terms of clinical course, severity, and histologic appearance. The simultaneous occurrence of Behçet syndrome and inflammatory disease of the colon was discussed in terms of the differential diagnosis of colitis.

Topics: Adult; Behcet Syndrome; Colitis; Colitis, Ulcerative; Colon; Diagnosis, Differential; Humans; Male; Mouth Mucosa; Radiography; Tetracycline

Topics: Administration, Oral; Adolescent; Adult; Aged; Ascorbic Acid; Child; Colitis, Ulcerative; Drug Therapy, Combination; Enema; Female; Humans; Hydrocortisone; Infusions, Parenteral; Injections, Intravenous; Male; Middle Aged; Parenteral Nutrition; Phosphates; Prednisolone; Remission, Spontaneous; Sulfasalazine; Tetracycline; Vitamin B Complex

Topics: Actinomyces; Actinomycosis; Aged; Anus Diseases; Colitis, Ulcerative; Crohn Disease; Diabetes Mellitus; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Male; Middle Aged; Penicillin G; Rectal Diseases; Rectal Fistula; Suppuration; Tetracycline

Topics: Adolescent; Child; Colectomy; Colitis, Ulcerative; Humans; Hydrocortisone; Male; Neoplasms; Prednisolone; Sulfasalazine; Tetracycline

Topics: Colitis, Ulcerative; Colonic Diseases, Functional; Diverticulitis, Colonic; Humans; Parasympatholytics; Pentazocine; Prednisolone; Steroids; Sulfamethoxazole; Sulfasalazine; Tetracycline; Trimethoprim

Topics: Chemical Precipitation; Colitis, Ulcerative; Drug Incompatibility; Humans; Hydrocortisone; Hydrogen-Ion Concentration; Prednisolone; Succinates; Tetracycline

Topics: Anti-Bacterial Agents; Bile Duct Neoplasms; Bile Ducts; Biopsy; Cholangitis; Cholestasis; Colectomy; Colitis, Ulcerative; Fatty Liver; Follow-Up Studies; Hepatitis; Humans; Inflammation; Liver; Liver Cirrhosis; Liver Cirrhosis, Biliary; Liver Diseases; Liver Function Tests; Portal System; Prednisolone; Sepsis; Tetracycline

Topics: Anti-Bacterial Agents; Cephalothin; Chloramphenicol; Colitis, Ulcerative; Colon; Dehydration; Diagnosis, Differential; Enterocolitis, Pseudomembranous; Female; Furazolidone; Humans; Intubation, Gastrointestinal; Middle Aged; Novobiocin; Otitis; Radiography; Sigmoidoscopy; Tetracycline; Water-Electrolyte Balance

Topics: Adolescent; Adult; Age Factors; Aged; Amebiasis; Child; Colitis; Colitis, Ulcerative; Dysentery, Amebic; Emetine; Empyema; Female; Hemagglutination Tests; Humans; Hypokalemia; Indians, North American; Liver Abscess, Amebic; Male; Middle Aged; Saskatchewan; Serum Albumin; Sex Factors; Sigmoidoscopy; Tetracycline

Topics: Adult; Aged; Chloramphenicol; Colectomy; Colitis, Ulcerative; Humans; Middle Aged; Prednisone; Streptomycin; Sulfasalazine; Tetracycline

Topics: Animals; Colitis, Ulcerative; Dogs; Intestinal Obstruction; Intestines; Methacholine Compounds; Tetracycline

Topics: Colitis, Ulcerative; Cortisone; Dexamethasone; Diet Therapy; Humans; Psychophysiologic Disorders; Psychotherapy; Tetracycline; Water-Electrolyte Balance

Topics: Adult; Cholangitis; Colectomy; Colitis, Ulcerative; Humans; In Vitro Techniques; Liver; Liver Function Tests; Male; Prednisone; Tetracycline

Topics: Anti-Bacterial Agents; Candidiasis; Chloramphenicol; Colistin; Colitis, Ulcerative; Erythromycin; Escherichia coli Infections; Gastrointestinal Hemorrhage; Humans; Intestines; Penicillins; Peptic Ulcer Perforation; Polyps; Proteus Infections; Staphylococcal Infections; Streptomycin; Tetracycline

Topics: Anti-Bacterial Agents; Cholangitis; Colitis; Colitis, Ulcerative; Humans; Liver; Tetracycline