The role of antibiotics in inflammatory bowel disease

Abstract

Antibiotics are the mainstay of therapy for patients with
Crohn's disease who present with localized peritonitis due
to a microperforation and bacterial overgrowth secondary
to chronic strictures. They are essential adjuncts to drainage
therapy for Crohn's disease-associated abscesses and for
perineal disease. Antibiotics have a role as primary therapy
in active uncomplicated CD. The efficacy of their response
must be considered in well-defined subsets of patients. Ciprofloxacin
and metronidazole, the two most widely studied
antibiotics, are effective therapy for patients with active ileocolonic
and colonic disease and have been shown to reduce
recurrence rates after ileocolonic resection. The benefits of
these drugs are less clear for patients with uncomplicated ileal
disease. Ciprofloxacin and metronidazole may also serve
as an adjunct to immunomodulator therapy. In toxic patients
with fulminant ulcerative colitis, with or without megacolon,
antibiotics should be administered along with corticosteroids
and other supporting measures. In less severely ill patients
requiring hospitalization, antibiotics may be given to
cover for the potential of a superimposed infection until the
workup for infection, including Clostridium difficile, amoeba
and salmonella is available. There may be a subset of patients
with severe nontoxic colitis who respond to antibiotics,
but to date controlled trials have not shown efficacy in this
group. However, antibiotics should not be routinely used for
mild to moderately ulcerative colitis, although a trial of ciprofloxacin
is not unreasonable prior to colectomy for otherwise refractory patients. The use of rifaximin in UC seems
promising but further evaluation is required. Altough further
clinical trials evaluating the role of antibiotics in inflammatory
bowel disease are required the available data are in favour
of the widely adopted assumption that antibiotics are
useful and valuable drugs in patients with either Crohn's disease
or ulcerative colitis.