Ulcerative Colitis: Response rates promising for amoxicillin, tetracycline, and metronidazole combo. Bacteria are widely suspected to be one of the inciting antigens in ulcerative colitis (UC). As such, antibiotics, probiotics, and fecal microbiota transplantation have all been established or proposed as treatments for UC. An open-label multi-center trial assessed the efficacy of a combination of amoxicillin (500 mg), tetracycline (500 mg), and metronidazole (250 mg) 3 times daily for 2 weeks to induce and maintain remission in patients refractory to or dependent on steroids (by treating elevated levels of Fusobacterium varium observed in inflamed colonic mucosa of patients with ulcerative colitis). Among 30 patients with steroid-refractory, active UC and 64 patients with steroid-dependent, active UC, a clinical response was achieved in 63.3% and 73.4%, respectively, within 2 weeks of completing therapy. At 3 and 12 months after completion, rates of clinical remission were 60.0% and 66.6% in steroid-refractory patients and 56.3% and 51.6% in steroid-dependent patients. At 3 and 12 months after completion, mucosal healing rates were 46.7% and 53.3% for steroid-refractory patients and 32.8% and 35.9% for steroid-dependent patients. In steroid-dependent patients, 60.9% were able to discontinue steroid therapy and remain in remission for ≥3 months. The minimal cost and toxicity of this treatment compared with conventional alternatives suggest that this regimen is worth following closely for its potential to treat ulcerative colitis. It is also reasonable for use in clinical practice pending additional research. One caveat: Tetracycline is currently not readily availale in the US.
Posted on: Fri, 23 May 2014 02:05:57 +0000
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