一项概念验证研究表明，在伴有小肠细菌过度生长的肠易激综合征中，抗生素比在不伴有小肠细菌过度生长的肠易激综合征中更有效：一项随机、双盲、安慰剂对照试验。
A proof-of-concept study showing antibiotics to be more effective in irritable bowel syndrome with than without small-intestinal bacterial overgrowth: a randomized, double-blind, placebo-controlled trial.
作者信息
Ghoshal Uday C, Srivastava Deepakshi, Misra Asha, Ghoshal Ujjala
机构信息
Departments of aGastroenterology bMicrobiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
出版信息
Eur J Gastroenterol Hepatol. 2016 Mar;28(3):281-9. doi: 10.1097/MEG.0000000000000557.
BACKGROUND
Antibiotics relieve symptoms in half of the unselected patients with irritable bowel syndrome (IBS); however, their efficacy if selected according to small-intestinal bacterial overgrowth (SIBO) is unknown.
AIMS
The aim of this study was to evaluate (a) symptom resolution among IBS patients with or without SIBO on norfloxacin treatment, and (b) its efficacy in obtaining negative SIBO test results as compared with placebo.
METHOD
Eighty IBS patients (Rome III) were evaluated for SIBO by gut aspirate culture. Patients with (≥10 CFU/ml) and those without SIBO were separately randomized (computer-generated stratified) to 800 mg/day norfloxacin for 10 days or placebo. Global symptom score (blindly), Rome III criteria, aspirate culture, and glucose hydrogen breath test (GHBT) were assessed before and 1 month after treatment, and patients were followed up for 6 months.
RESULTS
Although norfloxacin was more effective at reducing the symptom score at 1 month among patients with compared with those without SIBO [15/80, 19% on culture, four on GHBT too; 6.5 (2-13) vs. 2 (0-10), P=0.01; 8.5 (2-16) vs. 5 (0-12), P<0.001] but not placebo, the scores were comparable at 6 months [3 (1-10) vs. 9 (5-19), P=NS]. Symptoms more often resolved to turn Rome III negative in SIBO patients treated with norfloxacin compared with placebo at 1 month (7/8, 87.5 vs. 0/7, P=0.004); of the other 65 patients, 8/32 (25%) treated with norfloxacin but none of the 33 treated with placebo turned Rome III negative. Patients without SIBO and a colony count of 10-10 CFU/ml responded more than those with a colony count less than 10 CFU/ml. Overall, 15/40 (37.5%) patients responded to norfloxacin. At 6 months, 2/8 (25%) with and 5/32 (15.6%) without SIBO remained Rome III negative following norfloxacin. All 4/8 consenting patients treated with norfloxacin became SIBO negative (two each by culture+GHBT and GHBT alone), but 0/7 patients treated with placebo became SIBO negative.
CONCLUSION
Norfloxacin is superior to placebo in relieving symptoms of SIBO-associated IBS.
背景
抗生素可缓解半数未经挑选的肠易激综合征（IBS）患者的症状；然而，根据小肠细菌过度生长（SIBO）情况选择使用抗生素时其疗效尚不清楚。
目的
本研究旨在评估（a）诺氟沙星治疗下有或无SIBO的IBS患者的症状缓解情况，以及（b）与安慰剂相比，其使SIBO检测结果呈阴性的疗效。
方法
通过肠道抽吸物培养对80例IBS患者（罗马Ⅲ标准）进行SIBO评估。SIBO患者（≥10 CFU/ml）和无SIBO患者分别随机分组（计算机生成分层），接受800mg/天诺氟沙星治疗10天或安慰剂治疗。在治疗前及治疗1个月后评估总体症状评分（盲法）、罗马Ⅲ标准、抽吸物培养及葡萄糖氢呼气试验（GHBT），并对患者随访6个月。
结果
尽管与无SIBO患者相比，诺氟沙星在治疗1个月时对有SIBO患者降低症状评分更有效[培养阳性15/80例（19%），GHBT阳性4例；6.5（2 - 13）对2（0 - 10），P = 0.01；8.5（2 - 16）对5（0 - 12），P < 0.001]，但对安慰剂组无效，6个月时评分相当[3（1 - 10）对9（5 - 19），P = 无统计学意义]。与安慰剂相比，诺氟沙星治疗的SIBO患者在1个月时症状更常缓解至罗马Ⅲ标准阴性（7/8，87.5%对0/7，P = 0.004）；在其他65例患者中，诺氟沙星治疗的8/32例（25%）罗马Ⅲ标准转为阴性，而安慰剂治疗的33例无一例转阴。菌落计数为10 - 10 CFU/ml的无SIBO患者比菌落计数小于10 CFU/ml的患者反应更好。总体而言，15/40例（37.5%）患者对诺氟沙星有反应。6个月时，诺氟沙星治疗后有SIBO的2/8例（25%）和无SIBO的5/32例（15.6%）仍为罗马Ⅲ标准阴性。所有4/8例同意接受诺氟沙星治疗的患者SIBO转为阴性（培养 + GHBT各2例及仅GHBT转阴2例），但接受安慰剂治疗的0/7例患者SIBO未转阴。
结论
诺氟沙星在缓解SIBO相关IBS症状方面优于安慰剂。
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