Doxycycline & increased risk of Crohn's

Stolen the below from Tesscorm thread.


**While a study linking doxycyline with crohns was done with patients using doxycycline for a longer time period, Stephen's prescription is for 5 weeks (so, not really a very 'short' period).

Given that the risk of contracting malaria is fairly low, I'm thinking perhaps it's not worth taking the risk of using doxycycline, especially as I know he will be reducing it's effectiveness by having some alcohol. (I don't mean to imply he'll be drinking all day, every day but... )

So, along with telling the GI that MLP's research says...and Dusty's gut says..., there's also CIC's counsel...

http://www.internalmedicinenews.com/...f9dbae8ac.html
http://www.nature.com/ajg/journal/va...g2010303a.html

**

My questions:-

How much does doxycyline increase the risk of Crohn's?

We were told by our GP there is no link between doxycyline and Crohn's.

My thirteen year old is currently taking a 6 month course of doxcycline for moderate cystic acne.

Does anyone know what is mean by safer acne medications?

Sarah was treated with doxycyline for acne as a 13-14 year old, also a 6 month course.

I have also just completed a 6 month course of doxcylcine for roscesea, and my symptoms of IBS are worse than prior to starting this course.

Any opinions welcome.

Potential association between the oral tetracycline class of antimicrobials used to treat acne and inflammatory bowel disease.
Margolis DJ, Fanelli M, Hoffstad O, Lewis JD.
Source
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. margo@mail.med.upenn.edu
Abstract

OBJECTIVES:
Previous studies have shown an association between isotretinoin and inflammatory bowel disease (IBD). The majority of patients prescribed isotretinoin for their acne are previously on an extended course of antibiotics. Therefore, it is important to consider antibiotic use as a confounding variable for the development of IBD.

METHODS:
We performed a retrospective cohort study using The Health Improvement Network database of the United Kingdom. We identified 94,487 individuals with acne who were followed up by a general practitioner for 406,294 person-years.

RESULTS:
>A prescription for minocycline was received by 24,085 individuals, for tetracycline/oxytetracycline by 38,603 individuals, and doxycycline by 15,032 individuals. IBD was noted in 41 individuals exposed to minocycline, 79 individuals exposed to tetracycline/oxytetracycline, 32 individuals exposed to doxycycline, and 55 (0.11%) individuals not exposed to any of these antibiotics. The hazard ratio (HR) for developing IBD for any exposure to a tetracycline antibiotic was 1.39 (1.02, 1.90). HRs for individual antibiotics were 1.19 (0.79, 1.79) for minocycline, 1.43 (1.02, 2.02) for tetracycline/oxytetracycline, and 1.63 (1.05, 2.52) for doxycycline. For ulcerative colitis, the associations (HR) were 1.10 (0.76, 1.82) for minocycline, 1.27 (0.78, 2.07) for tetracycline/oxytetracycline, and 1.06 (0.53, 2.13) for doxycycline. For Crohn's disease (CD), the associations (HR) were 1.28 (0.72, 2.30) for minocycline, 1.61 (0.995, 2.63) for tetracycline/oxytetracycline, and 2.25 (1.27 4.00) for doxycycline.

CONCLUSIONS:
Tetracycline class antibiotics, and particularly doxycycline use may be associated with the development of IBD, particularly CD. Potential confounding by previous doxycycline exposure should be considered when assessing whether treatment with other acne medications increases the risk of IBD.

http://www.ncbi.nlm.nih.gov/pubmed/20700115

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In view of this study I don't know that I would make the statement that there is no link with absolute certainty.

The antibiotics that were given to treat severe acne were minocycline, tetracycline/oxytetracycline, and doxycycline. The researchers found that there was a small increased risk of developing IBD for those taking these drugs, with the risk of Crohn's disease in those taking doxycycline rating at the highest risk. While developing IBD after taking one of these antibiotics is considered a rare event, it does raise the question of whether long-term antibiotic use factors into the Accutane/IBD equation.

http://ibdcrohns.about.com/b/2010/08/23/long-term-antibiotic-use-linked-to-ibd.htm

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My two had never taken antibiotics prior to Crohn's so I don't have any personal experience with them and their potential to cause Crohn's. As such I have not formulated an opinion regarding their role and Crohn's. Having said that I don't disagree that the potential is there.

There has certainly been discussion on this forum in the past regarding IBD and Accutane and the lawsuits that were being brought against the manufacturer, Roche IIRC.

Sorry I can't be of more help Catherine.

Dusty. xxx

Thank you Dusty.

I spoken to my husband about the possible association between doxycycline and Crohn's and his first words were to get her off it.

I think we need to see if we can find a safer treatment. I don't want to increase my youngest daughter's risk factors.

I am not familiar with acne treatments Catherine but I so feel for you and your daughter. You are now in that risk v's benefit category with antibiotics and Isotretinoin (Accuatane) is also questionable.

This is a link to a Mayo Clinic article regarding acne. It covers all aspects including treatment from prescribed treatments through to alternatives so I hope you can pull from some useful information from it...

http://www.mayoclinic.com/health/acne/DS00169/DSECTION=treatments-and-drugs

Good luck hun. :heart:

Dusty. xxx

Hi Catherine,

There are many different treatments for acne -- I would recommend that you discuss your concerns with your daughter's dermatologist.

Good luck!

Catherine said:

So, along with telling the GI that MLP's research says...and Dusty's gut says..., there's also CIC's counsel...

.

Click to expand...

:yfaint:

It's just a matter of time before this forum finds a cure.:smile:

My daughter doesnot have a dermatologist. I have one who said the only association is between Crohn's and accutane.

We will not stop the medication without seeing our gp.

Hi Catherine, my oldest (non Crohnie) has cystic acne and that is how all this came up between Tesscorm and I. Her derm perscribed doxy. I mentioned the things I read and the fact that her younger sister had Crohns. Told her I would rather not use the doxy if I could avoid it. She said the medical community is not ready to link doxy and Crohns but that my concerns were very real. The other option was birth control pills which actually have a greater effectiveness in clearing the acne but their own set of problems. In the end my daughter did the doxy and some topical antibiotics (her choice). Worked as long as she took them but as soon as the perscription was done it came right back. We aren't ready to keep our daughter on them long term so we stopped all together.

Spoke with our GI about them. He also isn't convinced but said my hesitation was totally understandable. His main concern about antibiotics is their effect on the GI tract. He says why wake the sleeping giant if you don't have to. He also is concerned with antibiotic use and the fact that it increses your risk of getting c diff. He says that the incidence of c diff even if you haven't been in a hospital setting is increasing at a concerning rate. With Crohns and antibiotic use it increases the kids risks. This is why he asks that all docs run anything they perscribe by him first. Some antibiotics carry less risk than others. Not to mention with all the other stuff she is on better to have a clearing house managing her meds.

As for the acne, my daughter also can not use salicylic acid or Ben peroxide as it burns her skin off and she swells like an oompa loompa. We have found some stuff (thanks Tesscorm) that did a great job for a while but with my daughter we have to keep changing. It was made by a company here called Alloette. Visable aid. No BP or SA in it. Apparently the aloe is the magic. IDK what it was but it worked.

Oh yeah and my oldest is a swimmer also. Derm told us lots of bacteria in the water. Gets into her pores etc. Wash real well after swim practice and apply acne treatment right away.

Oh yeah we also got her one of those fancy electronic brushes that help wash the face better. Again, IDK if it worked but it feels real good!

Good luck!

At the time that C started experiencing his first symptoms he had been on doxy for a little over a month. He was on doxy for acne and his gp had put him on it. I'm not saying that the doxy caused CD but I think it woke the giant by stomping on his head!

My youngest is a swimmer as well.

The acne has almost completely cleared. When we first saw the gp about it I was concerned it was not normal teenager acne.

I am thinking switching her back to baby shampoo as it seeming to follow the hairline. This is my child with sunscreen allergy.

I already have one child who developed Crohn's after doing a six month course of doxycycline. (She may have had symptoms prior to use). Don't want to increase the risks for another.

Hi Catherine,

I'll just tell you our experience with Doxy...

Gabrielle started it in the summer when she was 16 years old for her acne.
We did not know she had Crohn's at the time (she was suspected at 9, but that went no where)
After about 2 months of being on the doxy, she started to develop severe mouth ulcers (upwards of 25+), and just "wasn't feeling good". We stopped the meds, then about 2 months later that's when she got very sick and hospitalized with viral hepatitis and Mono :/
Then, it all went down hill from there...

I'm not blaming the doxy per-say, but I will tell you when she was first diagnosed that was my very first thought.
:ghug:

Best of luck !
Sorry if this isn't what you wanted to hear

I don't really believe this med caused Sarah's Crohn's she already had low iron levels that didn't response normally to iron supplements and low body weight.

It may have speed the development but was not the cause.

Yes. That is what our doc says. You are either going to get Crohns or not. All the environmental factors, diet, meds, chemicals etc speed it up or make it worse but you were going to get it sooner or later. Haha, this talk came after I welled up in tears that I had caused O's Crohns somehow.

I just found this thread and wanted to add in our experience with doxy.

My daughter was on doxy for cystic acne for a couple of years. She would also take a probiotic but not on a completely regular basis. Pill compliance has always been difficult.

This April, she was dx'd with a severe crohn's. I can't help but think there is not only a connection between cystic acne and crohn's but I'm almost positive the doxy didn't help. From what I've read, Accutane would have been just as dangerous of a medication to take as well.

Wouldn't it be nice for the dermatologist to consider cystic acne as a warning sign of crohn's???

Stephen never had any issue with acne, so no treatments at all. However, as in the opening post, I think there's enough of a connection that I didn't give him the med (for malaria prevention).

I don't believe that doxy (or anything else) causes crohns but I do believe certain things will 'wake that giant'. If you are susceptible (have the gene or whatever the 'giant' is), I believe it's likely 'something' will trigger it during your lifetime.

Stephen had a sore back (started with an injury) for a year+ before his diagnosis, we assumed he was constantly rehurting his back through his activities and his GP recommended advil before every hockey game/practice, and whenever else necessary. Three or four months after starting advil regularly, he may have had a couple of small signs of crohns (or cud simply have been a 'bug'), another three months and symptoms returned much worse (advil use had continued through this time). When he was diagnosed, I spoke with the GI about the back ache and advil... his comment was that the continuing back ache, while beginning with an injury, may or may not have been related to the intestinal inflammation AND/OR the advils may have triggered crohns but would not have caused it.

But, whether causing or triggering, if possible, I now avoid anything that has shown any connection for both Stephen and my daughter (even though she doesn't have crohns). I'm not able to avoid everything with any connection but I will minimize the exposures where/when possible.

My son was diagnosed with CD after being treated for cystic acne with doxy for 3 months. Yes, there was a genetic predisposition for CD, as his sister has CD, but I don't know....he became very sick and diagnosed 3 months after treatment with doxy...this drug definitely sent him into a downward spiral with CD!

For those of us who have used doxy (or any other antibiotic) and suspect that it has contributed to the onset or flare of IBD, we can report it here http://www.fda.gov/Safety/MedWatch/HowToReport/default.htm so that the FDA and physicians will eventually have to pay attn to this unfortunate connection that we now know to be true.

I'm sending my report in today.

Catherine said:

I have one who said the only association is between Crohn's and accutane.

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They don't find any association in large scale studies.






What is far more likely is that the peyer's patches, localised in the small intestine and most active during teenage years, are the reason why crohn's disease is mostly diagnosed in those years.

It also happens to be the same demographic that uses products against acne...random coincidence.

Van Kruiningen's studies on CD have all been excellent, he's one of the first people who mentioned the relationship of the lymphatic system with crohn's disease.

I think you can make a case for the antibiotics though, especially broad spectrum ones. Your gut flora is part of your immune system, you can argue that using an antibiotic depletes part of this flora, which allows a pathogen to enter or manifest itself. To induce an intestinal infection with E Coli they often use broad spectrum antibiotics on mice, using antibotics on mice is a great way to facilitate an infection.

But the biggest users and abusers of antibiotics have been Africa and China, antibiotics abuse in China has been going on for decades, and they have had low incidence of crohn's disease for decades too, how does one explain that. Africa is a big user of antibiotics too, and they have extremely low incidence of crohn's disease, how does one explain that. Oh well.

You'd also expect certain groups of heavy antibiotics users to be more vulnerable to crohn's disease, AIDS patients almost never get crohn's disease. It's extremely extremely rare for an AIDS patient to get CD.

(I don't want to suggest anything, I don't think anyone should stop using an antibiotic just because there is a minuscule chance it might or might not be related to the development of CD, you might as well go live in a sealed off box then)