Presenter Status
Resident/Psychology Intern
Abstract Type
Research
Primary Mentor
Dr. Alka Goyal
Start Date
12-5-2021 11:30 AM
End Date
12-5-2021 1:30 PM
Presentation Type
Poster Presentation
Description
Background: Antibiotic cocktail targeting intestinal bacteria may offer a promising approach in certain patients with medically refractory IBD. It may find a place in serving as a bridge to more effective long-term medical therapies and in some cases help in achieving clinical remission in patients with refractory disease as an adjunctive therapy. Its main attractions include efficacy in about 50% of medically refractory patients and a non-immunosuppressive adjunct in treatment of children who may otherwise suffer from complications of untreated disease or heavy immunosuppression. The main drawbacks are lack of understanding of true mechanism of action, potential development of drug resistant bacterial colonies, and gaps in knowledge about optimal duration of therapy and the patient phenotypes most likely to benefit. Pediatric data is sparse regarding efficacy, indications and treatment protocol.
Objectives/Goal: By conducting this retrospective analysis, we hope to contribute towards knowledge that can verify efficacy of antibiotic cocktail therapy and further identify various patient and treatment related factors that are associated with its response.
Methods/Design: Patients with IBD between the ages of 1 year and 22 years who were treated with an antibiotic cocktail consisting of at least 3 drugs (most commonly: metronidazole, amoxicillin, doxycycline, and vancomycin) for a minimum of 1 week for medically refractory disease were included for retrospective chart review. Children who had undergone simultaneous changes in IBD therapy within 4 weeks of starting antibiotics were excluded.
Results: 19 children were included: mean age 10.8 ± 4.6 years, 8 females (42%), 18 (95%) with moderate to severe disease activity, 8 (42%) with Crohn’s colitis, 5 (29%) with ulcerative colitis, 4 (21%) with indeterminate colitis. 7 (37%) patients were corticosteroid-dependent or resistant and 18 (95%) had shown poor response to anti-TNF therapy. The antibiotic cocktail was definitely effective in 12 of 19 patients who entered clinical remission following therapy (PUCAI < 10). By diagnosis, 2 (40%) with ulcerative colitis, 6 (75%) with Crohn’s colitis, and 4 (80%) with indeterminate colitis responded. 4 (21%) patients developed Clostridium difficile infection after undergoing therapy. 4 patients (21%) ultimately required colectomy for medically refractory disease.
Conclusions: The use of oral wide-spectrum antibiotic cocktail in pediatric IBD seems promising and safe in children refractory to other salvage therapy. Further study, including a randomized controlled study, is warranted to further assess the efficacy of this intervention.
MeSH Keywords
Inflammatory Bowel Disease, Antibiotics, Children, Acute Severe Colitis
Additional Files
Efficacy of using antibiotic cocktail in medically refractory col.pdf (190 kB)Abstract
Included in
Efficacy of using antibiotic cocktail in medically refractory colitis/inflammatory bowel disease
Background: Antibiotic cocktail targeting intestinal bacteria may offer a promising approach in certain patients with medically refractory IBD. It may find a place in serving as a bridge to more effective long-term medical therapies and in some cases help in achieving clinical remission in patients with refractory disease as an adjunctive therapy. Its main attractions include efficacy in about 50% of medically refractory patients and a non-immunosuppressive adjunct in treatment of children who may otherwise suffer from complications of untreated disease or heavy immunosuppression. The main drawbacks are lack of understanding of true mechanism of action, potential development of drug resistant bacterial colonies, and gaps in knowledge about optimal duration of therapy and the patient phenotypes most likely to benefit. Pediatric data is sparse regarding efficacy, indications and treatment protocol.
Objectives/Goal: By conducting this retrospective analysis, we hope to contribute towards knowledge that can verify efficacy of antibiotic cocktail therapy and further identify various patient and treatment related factors that are associated with its response.
Methods/Design: Patients with IBD between the ages of 1 year and 22 years who were treated with an antibiotic cocktail consisting of at least 3 drugs (most commonly: metronidazole, amoxicillin, doxycycline, and vancomycin) for a minimum of 1 week for medically refractory disease were included for retrospective chart review. Children who had undergone simultaneous changes in IBD therapy within 4 weeks of starting antibiotics were excluded.
Results: 19 children were included: mean age 10.8 ± 4.6 years, 8 females (42%), 18 (95%) with moderate to severe disease activity, 8 (42%) with Crohn’s colitis, 5 (29%) with ulcerative colitis, 4 (21%) with indeterminate colitis. 7 (37%) patients were corticosteroid-dependent or resistant and 18 (95%) had shown poor response to anti-TNF therapy. The antibiotic cocktail was definitely effective in 12 of 19 patients who entered clinical remission following therapy (PUCAI < 10). By diagnosis, 2 (40%) with ulcerative colitis, 6 (75%) with Crohn’s colitis, and 4 (80%) with indeterminate colitis responded. 4 (21%) patients developed Clostridium difficile infection after undergoing therapy. 4 patients (21%) ultimately required colectomy for medically refractory disease.
Conclusions: The use of oral wide-spectrum antibiotic cocktail in pediatric IBD seems promising and safe in children refractory to other salvage therapy. Further study, including a randomized controlled study, is warranted to further assess the efficacy of this intervention.
