Introduction: Current
therapies in pediatric
Inflammatory Bowel Diseases (IBD) target the immune system and often fail to sustain long-term remission. There is a high need for development of alternative treatment strategies such as
antibiotics in pediatric IBD.Areas covered: This study systematically assessed efficacy and safety of
antibiotics in pediatric IBD. CENTRAL, EMBASE, and Medline were searched for Randomized Controlled Trials (RCTs). Quality assessment was conducted with the Cochrane risk-of-bias tool.Expert opinion: Two RCTs (n = 101, 4.4-18 years, 43% male) were included. Both studies had overall low risk of bias. In mild-to-moderate
Crohn's disease, azithromycin+metronidazole (AZ+MET) (n = 35) compared to
metronidazole (MET) alone (n = 38) did not induce a significantly different response (PCDAI drop ≥12.5 or remission) (p = 0.07). For
induction of remission (PCDAI≤10), AZ+MET was more effective than MET (p = 0.025). In Acute Severe
Colitis, mean 5-day-PUCAI was significantly lower in the
antibiotic (
vancomycin,
amoxicillin,
metronidazole,
doxycycline)+intravenous-
corticosteroids group (AB+IVCS) (n = 16) compared to IVCS alone (n=12) (p = 0.037), whereas remission (PUCAI<10) did not differ (p = 0.61). No significant
drug-related adverse events were reported. Results of this systematic review of
antibiotic use highlight the lack of evidence in pediatric IBD. More evidence is needed before widespread implementation in daily practice.