The role of antibiotics in the management of IBD: is there evidence at all?

http://www.ncbi.nlm.nih.gov/pubmed/22796797

Pineton de Chambrun GP, Torres J, Darfeuille-Michaud A, Colombel JF.

Université Lille Nord de France, Lille, France.

2012

30(4):358-67

BACKGROUND/AIMS:

The etiology of IBD is unknown but may relate to an unidentified bacterial pathogen or an immunological reaction to gut microbiota. Antibiotics have therefore been proposed as a therapy for Crohn's disease (CD) and ulcerative colitis (UC). The aim of this review was to compel the evidence for the use of antibiotics in the treatment of IBD.

METHODS:

We performed a systematic review of the literature regarding the use of antibiotics for inducing or maintaining remission in IBD.

RESULTS:

Current data are conflicting, but a recent systematic review of randomized controlled trials has shown a statistically significant effect of antibiotics being superior to placebo for active, perianal and quiescent CD and for active UC. These data have been poorly translated in clinical practice and the place of antibiotics is restricted to certain specific situations in the international guidelines. This is first linked to the difficulties in interpreting clinical trials because of their heterogeneity in study design, endpoints, type of antibiotic and concomitant therapies. The exception to this is the use of either ciprofloxacin or metronidazole for treating CD perianal fistulas.

CONCLUSION:

The pathology of CD, the likely primary and known secondary pathogens in this disease and the successful responses in animal models all plead for new trials of antibiotics in IBD. This is a call to select patients more carefully, and to continue antibiotics for longer than is customary. Beside antibiotics, new therapeutic approaches that can balance gut dysbiosis should be tested.

Rifaximin and Rifampicin are two very different antibiotics, rifaximin sounds great because it's lower bioavailable and it has very few side effect, but it doesn't penetrate cells well, which doesn't make it very effective against AIEC or MAP. And on top of that Rifaximin creates cross resistance with rifampicin.

They do something though, even amoxicillin is slightly effective against certain MAP and AIEC strains, just not a lot, but rifaximin is going to create resistance for rifampicin, unlike amoxicillin.

The reason rifaximin works can't be because it's killing AIEC or MAP I believe, it's just lowering bacterial load.

And if you just want to lower bacterial load, why not use amoxicillin instead so you don't create cross resistance with rifampicin and cipro etc.

Cipro, azithromycin, rifampicin, clofazimine, dapsone, those are the the ones that can penetrate cells.

What about clyndamycin?
Where does it fit ?

Strange summary! What are you talking about!? Did you try Xifaxan or Cipro and Metronidazole? I am about two years on antibiotics. Side effects from Cipro and Metronidazole very dangerous! Xifaxan – great drug, no side effects! I was on low and high dose of Xifaxan and I did not achieve any resistant!

kiny said:

Rifaximin and Rifampicin are two very different antibiotics, rifaximin sounds great because it's lower bioavailable and it has very few side effect, but it doesn't penetrate cells well, which doesn't make it very effective against AIEC or MAP. And on top of that Rifaximin creates cross resistance with rifampicin.

They do something though, even amoxicillin is slightly effective against certain MAP and AIEC strains, just not a lot, but rifaximin is going to create resistance for rifampicin, unlike amoxicillin.

The reason rifaximin works can't be because it's killing AIEC or MAP I believe, it's just lowering bacterial load.

And if you just want to lower bacterial load, why not use amoxicillin instead so you don't create cross resistance with rifampicin and cipro etc.

Cipro, azithromycin, rifampicin, clofazimine, dapsone, those are the the ones that can penetrate cells.

Click to expand...

Nothing related practical cases!

The cross resistance is common with AIEC, I can find some articles again, but resistance is high after a while.

We need more practical cases but the other drugs are so expensive that doctors are getting bribed left and right to avoid even trying antibiotics. They should make new antibiotics specifically targeting AIEC and specifically targeting the individual strains like the study suggested, one that have low bioavailability like rifaximin but rifaximin isn't strong enough against AIEC, and it's creating resistane. There was an article someone posted a while ago that they were studying a new version of rifaximin, they really need to get started with this, the money doctors and companies are making from the dangerous immune drugs is causing the hurdles in antibiotics therapy for crohn.

It's the same thing with probiotics, there are institutions trying to stop them from progressing with their research, the PH drop lactobassilli create limits progress AIEC can make, in France there is a lot of research going on to discover which probiotic strains have an effect for crohn.

I don't know btw, penguin, only familiar with a few.

I was just about to ask my doctor about using antibiotics potentially long term! I recently had some dental work which required me to pre/post medicate with penicillin! During those 3 weeks, I felt so much better, probably the best I've felt since being diagnosed as well as having good consistent bowel movements! Is penicillin able to help crohns or was this all a coincidence? I made no other changes during this period so it seemed logical to think it was the penicillin!

It's possible that antibiotics that simply remove part of the gut flora and lower bacterial load improve crohn, when people have surgeries they have noticed that parts of the bowel that are low on bacterial load heal much faster.

(I think this is why Rifaximin works in that study above, it isn't strong enough to kill AIEC but it's helping crohn, the only thing rifaximin is good at is decreasing bacterial load)

But remember that bacteria, pathogenic ones, like AIEC, need antibiotics in mice experiments to begin growing in the first place, it's a double edged sword, while the gut flora might make healing a bit slower or even impede it at time, it's also protecting you from further AIEC spread if you have AIEC in your bowel, which many people with crohn's disease have.

This is why doctors who still ignore probiotics are idiots imo, the dysbiosis antibiotics can create is the perfect breeding ground for AIEC, probiotics counters this by lowering the amount of surface area AIEC has to grow on and by lowering PH and inflammation, which impacts their ability to multiply. AIEC exploits inflammation.

So do you think I should ask him or try it kiny?

Don't ever want to say anyone what to do, there are penicillin-like antibiotics like amoxicillin (augmentin) and then there's antibiotics like rifaximin, they're not heavy antibiotics like cipro and clari, which means they have very low side effects. Don't want to say what to do, but if you feel better yes ask away, I felt better for weeks on amoxicillin and probiotics, no I don't kow why and I don't care, the fact it helped me is enough for me.

I def understand Kiny! I just couldn't believe how well I felt and its obvious the only thing I was doing different was taking penicillin! I felt better than I had in 2-1/2 years since my diagnosis and I think it's worth a try to see if it works!

Do you have the citation for [14] above? I'm interested in the study they reference.

mbishop said:

Do you have the citation for [14] above? I'm interested in the study they reference.

Click to expand...

Khan KJ, Ullman TA, Ford AC, Abreu MT,
Abadir A, Marshall JK, et al: Antibiotic therapy
in inflammatory bowel disease: a systematic
review and meta-analysis. Am J Gastroenterol
2011; 106: 661–673.

I would honestly link the whole study if it wasn't for the copyright issues, don't want the site to get in trouble, but the relevant info is there imo and I can link the references np.

Thank you!