Turner Dan, Levine Arie, Kolho Kaija-Leena, Shaoul Ron, Ledder Oren
The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel.
Wolfson Medical Center, Holon, Israel.
J Crohns Colitis. 2014 Nov;8(11):1464-70. doi: 10.1016/j.crohns.2014.05.010. Epub 2014 Jun 20.
The results of previous studies on the effectiveness of antibiotics in ulcerative colitis (UC) seem more effective when used orally. In this retrospective, multicenter study, we aimed to report our experience of using a combination of 3-4 antibiotics in children with moderate-severe refractory UC and IBD-unclassified including metronidazole, amoxicillin, doxycycline, and if during hospital admission, also vancomycin (MADoV).
All children treated during 2013 with the antibiotic cocktail for 2-3weeks in an attempt to alleviate inflammation in refractory colitis were included. Doxycycline was substituted with oral gentamycin or ciprofloxacin in children younger than 8years or when an allergy was known to one of the drugs. Children were assessed using the PUCAI and CRP weekly for 3weeks.
All 15 included children had moderate to severe disease with refractory disease course to multiple immunosuppressants (mean age 13.6±5.1years, median disease duration 2 (IQR 0.8-3.2) years, 11 females (73%), and 13 (87%) extensive disease; 14 (93%) were corticosteroid-dependent or resistant, and 12 (80%) refractory to anti-TNF therapy). The cocktail was definitely effective in 7 of the 15 included children (47%) who entered complete clinical remission (PUCAI<10) without additional interventions. Questionable or partial short-term response was noted in another 3 (20%), totaling 67% of patients.
The use of oral wide-spectrum antibiotic cocktail in pediatric UC seems promising in half of patients, refractory to other salvage therapy. A pediatric randomized controlled trial to assess this intervention is underway.
先前关于抗生素治疗溃疡性结肠炎（UC）有效性的研究结果显示，口服使用时似乎更有效。在这项回顾性多中心研究中，我们旨在报告我们在中重度难治性UC和未分类炎症性肠病（IBD）患儿中联合使用3 - 4种抗生素（包括甲硝唑、阿莫西林、强力霉素，若住院则加用万古霉素，即MADoV）的经验。
纳入2013年期间接受抗生素联合治疗2 - 3周以缓解难治性结肠炎炎症的所有患儿。8岁以下儿童或已知对其中一种药物过敏时，用口服庆大霉素或环丙沙星替代强力霉素。每周使用儿童溃疡性结肠炎活动指数（PUCAI）和C反应蛋白（CRP）对患儿进行3周评估。
纳入的15名患儿均患有中重度疾病，对多种免疫抑制剂治疗呈难治性病程（平均年龄13.6±5.1岁，疾病持续时间中位数为2（四分位间距0.8 - 3.2）年，11名女性（73%），13名（87%）为广泛性疾病；14名（93%）依赖或抵抗皮质类固醇，12名（80%）对抗肿瘤坏死因子（TNF）治疗难治）。在15名纳入患儿中，7名（47%）在未进行额外干预的情况下实现了完全临床缓解（PUCAI<10），该联合治疗明确有效。另外3名（20%）患儿有可疑或部分短期反应，总计67%的患者有反应。
在难治性其他挽救治疗的小儿UC患者中，约半数患者使用口服广谱抗生素联合治疗似乎有前景。一项评估该干预措施的儿科随机对照试验正在进行中。
