A Comparative Study of Metronidazole and Sulfasalazine in Active, Not Severe, Ulcerative Colitis

Gilat, Tuvia; Suissa, Alain; Leichtman, G; Delpre, G; Pavlotzky, M; Grossman, Andrew B.; Fireman, Zvi

doi:10.1097/00004836-198708000-00011

Cited by 55 publications

(14 citation statements)

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“…The routine use of antibiotics is not recommended in mild or moderate UC. In a prospective, double-blind, randomized controlled trial reported by Gilat et al (23), oral metronidazole and sulfasalazine were used for the outpatient management of mild to moderate UC. This revealed that metronidazole was significantly less effective than sulfasalazine by endoscopic and clinical criteria.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of broad-spectrum antibiotic therapy in patients with active inflammatory bowel disease

Wang

Yang

2012

Experimental and Therapeutic Medicine

108

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Patients with Crohn’s disease (CD) or ulcerative colitis (UC) undergo various therapies, including antibiotic therapy. This meta-analysis of controlled clinical trials was conducted to evaluate whether the use of antibacterial therapy improves the clinical symptoms of inflammatory bowel disease (IBD). The Medline and Scopus databases were searched and a systematic review was performed. Randomized, controlled trials in which antibiotic therapy was compared with placebo were investigated. A total of 10 randomized, placebo-controlled clinical trials for CD were included in the meta-analysis. The pooling of the data from these trials yielded an odds ratio (OR) of 1.35 [95% confidence interval (CI), 1.16–1.58] for antibiotic therapy compared with placebo in patients with CD. Furthermore, nine randomized placebo-controlled clinical trials for UC matched our criteria and were included in the analysis. The pooling of the data from these trials yielded an OR of 2.17 (95% CI, 1.54–3.05) in favor of antibiotic therapy. These results suggest that antibiotics improve clinical outcomes in patients with IBD.

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Section: Discussionmentioning

confidence: 99%

Meta-analysis of broad-spectrum antibiotic therapy in patients with active inflammatory bowel disease

Wang

Yang

2012

Experimental and Therapeutic Medicine

108

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“…Several RCTs are available regarding the use of antibiotics in the treatment of active UC [60,61,62,63,64,65,66,67,68,69,70]; the 2011 meta-analysis [14] included 9 that matched the quality criteria and give remission as an outcome [60,62,64,65,66,67,68,69,70]. These trials involved 662 patients with mostly moderately active UC, and they tested metronidazole, ciprofloxacin, tobramycin, vancomycin, amoxicillin, tetracycline and rifaximin, alone or in combination.…”

Section: Review Of the Evidencementioning

confidence: 99%

The Role of Anti(myco)bacterial Interventions in the Management of IBD: Is There Evidence at All?

Chambrun¹,

Torres

Darfeuille‐Michaud

et al. 2012

Dig Dis

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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.

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“…Gilat et al112 performed a randomized controlled trial in which 42 patients with acute, nonsevere ulcerative colitis received either oral metronidazole (1.35 g daily) or sulfasalazine (4.5 g daily) for 28 days. Twenty‐six percent (6 of 23) of patients in the metronidazole‐treated group improved compared with 68% (13 of 19) of patients in the sulfasalazine‐treated group, suggesting that oral metronidazole is ineffective in the treatment of acute, nonsevere ulcerative colitis.…”

Section: Use Of Antibiotics In Ulcerative Colitismentioning

confidence: 99%

Use of antibiotics in the treatment of inflammatory bowel disease

Perencevich

Burakoff

2006

Inflammatory Bowel Diseases

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An increasing amount of evidence suggests that enteric flora may have a role in the pathogenesis of inflammatory bowel disease (IBD). Patients with IBD appear to have an altered composition of luminal bacteria that may provide the stimulus for the chronic inflammation characterizing IBD. The suspected role of bacteria in the pathogenesis of IBD provides the rationale for using agents, such as antibiotics, that alter the intestinal flora. However, there remains much uncertainty about the optimal use of antibiotics in the treatment of Crohn's disease, ulcerative colitis, and pouchitis. This article reviews the literature and presents a clinical model for the use of antibiotics in IBD.

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A Comparative Study of Metronidazole and Sulfasalazine in Active, Not Severe, Ulcerative Colitis

Cited by 55 publications

References 0 publications

Meta-analysis of broad-spectrum antibiotic therapy in patients with active inflammatory bowel disease

Meta-analysis of broad-spectrum antibiotic therapy in patients with active inflammatory bowel disease

The Role of Anti(myco)bacterial Interventions in the Management of IBD: Is There Evidence at All?

Use of antibiotics in the treatment of inflammatory bowel disease

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