Antibiotics for the Treatment of Primary Sclerosing Cholangitis

Abstract

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease that is associated with considerable morbidity and mortality. The disease etiopathogenesis has not been well defined. Several observations suggest that portal bacteremia or chronic bile duct infection may be factors that could play a role in the pathogenesis of the disease. Clinical trials have tested different treatments for PSC but without convincing evidence of benefit. Liver transplantation is the only available therapeutic option that is thought to be beneficial for PSC. Antibiotics have been used in several case series over the years to treat PSC and have had, in some cases, impressive benefits when compared with other drugs used for treating the disease. We gathered the available data for different antibiotics used in PSC in this review. Further studies are needed to support the efficacy of using antibiotics for PSC patients.

Sclerosing Cholangitis: Pediatric Perspective

“…However, these agents may not control the disease in the long term, and chronic cholestasis may progress. Antibiotics, such as azithromycin and metronidazole, have been shown to improve liver enzymes in adults with PSC [24]. Oral vancomycin has also been shown to improve liver enzymes, erythrocyte sedimentation rate, and clinical symptoms in 14 children, especially in those without cirrhosis [25].…”

Primary sclerosing cholangitis and the microbiota: current knowledge and perspectives on etiopathogenesis and emerging therapies

“…Since the initial case series of antibiotics in PSC [56], several small studies have been published, the majority within the past 10 years [1,57]. Three of these were prospective clinical trials (Table I), all three of which showed reduction in the biomarker serum alkaline phosphatase (ALK) with antibiotic treatment (weighted average reduction of 41%) [19,58,59].…”

Curcumin and Liver Disease: from Chemistry to Medicine

“…Chronic fatigue, jaundice, itching, malabsorption, cirrhosis, enlarged liver, enlarged spleen, weight and appetite loss, and infection of the bile duct are the most common symptoms of primary sclerosing cholangitis (Miura and Miyachi 2009;Bowlus 2011;Elfaki and Lindor 2011;Ibrahim and Lindor 2011;Singal and others 2011;Azizi and others 2012). There are different medications for the treatment of primary sclerosing cholangitis such as cholestyramine (Mendes and Lindor 2010), ursodeoxycholic acid (Lindor and others 2009), antibiotics (Elfaki and Lindor 2011) (for treatment of bile duct infections), and some immunosuppressive drugs such as prednisone, azathioprine, cyclosporine, and methotrexate (Tabibian and Lindor 2013). Treatments with some vitamins such as vitamin D, vitamin E, vitamin A, and vitamin K have also shown to have some beneficial effects (Ibrahim and Lindor 2011).…”