Pretreatment with antibiotics may enhance the efficacy of fecal microbiota transplantation in ulcerative colitis: a meta-analysis

Abstract

fecal microbiota transplantation (FMT) and its challenges in treating inflammatory bowel disease (IBD). As highlighted by the authors, one of the major factors that may optimize FMT for IBD is how the recipient's bowel is prepared prior to an FMT. Theoretically, using antibiotics has the potential to ''make space for the new microbiota'' before FMT by freeing previously occupied niches.Recently, Ishikawa et al. 2 showed that administration of amoxicillin, fosfomycin, and metronidazole for 2 weeks prior to FMT improved bacterial dysbiosis in ulcerative colitis (UC) patients through transplantation of Bacteroidetes from donors in comparison to no pretreatment prior to FMT.In order to investigate how the administration of antibiotics before FMT affects the outcome (clinical remission) in adult UC patients, we performed a meta-analysis of previously published studies. Our search strategy was similar to the one used in Colman and Rubin's recent systematic review, 3 and we only included studies that were performed on adult UC patients. Comprehensive Meta-analysis, V.3 (Biostat, Englewood, NJ, USA) was used for statistical analysis. Overall effect (clinical remission rate in UC) was derived from the random effect model using the DerSimonian and Laird method, which takes betweenstudy variation into account. Betweensubgroup heterogeneity (antibiotics vs. no-antibiotics pretreatment) was assessed using the fixed-effect model.In total, nine studies (118 patients) were selected for this analysis. Two studies 4,5 were randomized controlled trials and we only included data from their FMT arms. The pooled remission rate following FMT in UC was 30.3% (95% confidence interval (CI) ¼ 19.3-44.2%). As shown in Figure 1, the remission rate after FMT was significantly higher in studies that used antibiotics as the pretreatment procedure in comparison to those that did not use any antibiotics before FMT (54.0% vs. 25.1%, P ¼ 0.03). Limitations to this analysis include significant heterogeneity related to the administration route, the use of fresh or frozen stool, and number of treatments. Figure 1 Forest plot of studies that performed fecal microbiota transplant on ulcerative colitis patients comparing pretreatment with or without antibiotics before fecal microbiota transplantation. CI, confidence interval.

Antibiotic‐Associated Disruption of Microbiota Composition and Function in Cirrhosis Is Restored by Fecal Transplant

“…However, the pre‐FMT postantibiotic sampling was able to shed light on the changes brought by the antibiotics and their resolution with FMT. We also studied three major antibiotics together rather than one at a time, which is not usual practice but was done to ensure a better uptake as has been shown in studies of FMT in patients without cirrhosis . However, given reports that antibiotic‐associated microbial changes can last for several months to years even in healthy individuals, it is highly unlikely that these changes reverting close to preantibiotic baseline will return to normal in this much more advanced population .…”

“…During this trial a pre‐FMT broad‐spectrum antibiotic course was administered in order to potentially increase the uptake of FMT. However, this also gave us an opportunity to study the impact of antibiotic therapy in this population and the changes wrought by FMT compared to standard of care (SOC) therapy . We found in the prior results that bacterial diversity was restored after FMT, but the effects of FMT on antibiotic‐associated changes in bacterial function in this population are unclear.…”

Gut microbiome interventions in human health and diseases

“…Both fresh and frozen stools are used in clinics and no differences in effects have been reported . Good effects can be achieved by using antibiotics to remove the intestinal microbiota of UC patients before FMT treatment . Adverse reactions include diarrhea, cramping, belching, constipation, and aspiration pneumonia in CDI patients and high fever in UC patients .…”

Microbial orchestra in juvenile idiopathic arthritis: Sounds of disarray?

“…Moreover, the study in children with ERA likewise demonstrated that the post‐intervention fecal specimens were not appreciably altered by the administration of the probiotic (Table ). Perhaps, then, therapeutic probiotics need to be preceded with antibiotics in order to facilitate uptake of the probiotics, as has been suggested for fecal transplant . Indeed, GF mice had substantially improved uptake of probiotics as compared to their conventionally housed counterparts .…”

“…Perhaps, then, therapeutic probiotics need to be preceded with antibiotics in order to facilitate uptake of the probiotics, as has been suggested for fecal transplant. 135 Indeed, GF mice had substantially improved uptake of probiotics as compared to their conventionally housed counterparts. 134 Finally, whether butyrate production is a viable target, despite its theoretical rationale, will be discussed below.…”