Antibiotics and Probiotics in Inflammatory Bowel Disease: Why, When, and How

Cosimo Prantera; Maria Lia Scribano


Curr Opin Gastroenterol. 2009;25(4):329-333. 

In This Article


The past year has not seen any major update to the topic 'antibiotic/probiotic in IBD'. However, two noteworthy studies have addressed major questions in Crohn's disease.[7,18••] The Australian trial has overcome two criticisms previously made regarding other antimycobacterial studies, that is the exceedingly brief time of treatment and the type of antibiotics – not specifically active against atypical mycobacteria – employed in previous studies.[7] The trial failed, mainly because the healing of lesions (an effect to be expected from a drug claimed to exert a therapeutic effect on the causative agent of Crohn's disease) was not obtained. To sum up, the trial does not confirm the hypothesis of mycobacterial cause in Crohn's disease, even if this possibility is not completely ruled out. In fact, a hypothetical infectious agent that commenced the inflammatory process may no longer be detectable, having long since left the initial crime scene.

The second study gives us important information on prevention of recurrent lesions of Crohn's disease.[18••] The combination of antibiotic and azathioprine seems an acceptable choice for providing patients with high risk of recurrence after surgery a chance of reduction of disease reappearance. Antibiotics alternative to metro, which is burdened by side effects that in turn affect patients' compliance, could improve the performance of this strategy.

In our opinion antibiotics are extremely useful for treating Crohn's disease complications, especially when the use of immunosuppressors may be counter-indicated because of abscesses and septic complications. In the active phases, when the colon is involved, they are a possible first-step therapy; however, there are serious doubts about their efficacy in Crohn's disease ileitis. The combination of antibiotics with steroids needs to be reassessed. There is no proof of antibiotic usefulness in ulcerative colitis; however, it is advisable to use them in case of severe colitis. Finally, the value of probiotics deserves to be further investigated.

We believe that a key research goal should be to discover new antibiotics with fewer side effects, a wide spectrum of activity, and low bacterial resistance. Another future assignment should be to test the efficacy of various combinations of antibiotics and the corresponding response of mucosal adherent bacteria.


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