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Long-term antibiotic treatment effective for Crohn’s disease

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Long-term treatment with clofazimine or nitroimidazoles may help control Crohn’s disease, according to the authors of a systematic review and meta-analysis.

Several bacteria have been implicated in Crohn’s disease, but antibiotics are currently recommended only for certain complications, such as sepsis or perianal disease, the researchers note in the February 15th issue of Clinical Infectious Diseases.

The meta-analysis, by Dr. Martin Feller from the University of Bern, Switzerland, and colleagues, pooled data from 16 randomized, placebo-controlled trials involving a total of 865 patients, in order to assess the effectiveness of long-term antibiotic treatment for Crohn’s disease. The outcomes were remission (in patients with active disease) or relapse (in patients with inactive disease).

The studies examined 13 different treatment regimens, ranging from single drugs to combinations of up to 4 drugs. The median treatment duration was 6 months. Four studies specifically excluded the use of steroids; the others either included them or allowed them to be added when indicated.

The quality of reporting of study methods was generally low, the authors report.

Three trials of nitroimidazoles (206 patients) showed a significant benefit (odds ratio, 3.54), the researchers note, as did 4 trials of clofazimine (322 patients; OR, 2.86).

The number of patients with active disease needed to treat to keep 1 additional patient in remission was 3.4 for nitroimidazoles and 4.2 for clofazimine. For inactive disease, the number needed to treat was 6.1 for nitroimidazoles and 6.9 for clofazimine.

One trial of ciprofloxacin, involving 47 patients, showed a benefit (OR, 11.3), but with a wide confidence interval.

Three trials involving 107 patients showed no benefit from treatment with classic anti-tuberculosis drugs.

The 4 studies of clarithromycin alone or in combination with other antibiotics (287 patients) were highly heterogeneous and could not be combined in the meta-analysis, according to the report.

“We believe that further research is justified to better define the role of antibacterial agents and combination regimens in Crohn’s disease,” the investigators say. “Future studies should focus on clofazimine, alone or in combination with a macrolide and a rifamycin, as well as in combination with a nitroimidazole, and perhaps ciprofloxacin.”

Clin Infect Dis 2010;50:473-480.

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