August 7, 2022

The use of antibiotics in the treatment of ulcerative colitis

What was the purpose of this review?

This Cochrane review aimed to find out whether antibiotics are useful and safe for people with ulcerative colitis (UC) to achieve or maintain remission.

Key messages

We found that antibiotics, when added to standard treatments, are similar to placebo in how often they fail to achieve remission or improvement in disease in people with UC, measured up to three months after taking them.

We found that antibiotics, when compared with placebo, may be helpful in achieving remission or some improvement in UC symptoms, measured at 12 months after taking them.

In terms of safety, the evidence is of low certainty, but antibiotics may be as safe as placebo.

We are confident in the results up to three months, but less confident in the evidence at 12 months due to the small number of study participants.

What is ulcerative colitis?

UC is a chronic (long-term) inflammatory disease that affects the large intestine. The most common symptoms include bloody diarrhea, abdominal pain, and a sudden, almost uncontrollable urge to have a bowel movement. Some people have other symptoms, including joint pain, mouth sores, and eye inflammation. When a person has symptoms of UC, they are said to have “active” disease. When symptoms improve with treatment, the disease is said to be responding to treatment. When the symptoms stop, the disease is said to be in “remission”. People with UC in remission often receive therapy with drugs to try to prolong (maintain) their remission or response to treatment.

What did the exam study?

This review investigated the use of antibiotics in the treatment of UC. Eleven studies considered antibiotics as therapy to achieve remission and one study as therapy to maintain remission.

Antibiotics could theoretically be helpful as they may be able to fight off harmful bacteria in the gut that are thought to be a partial cause of the presence of UC symptoms.

Currently, most doctors do not recommend the use of antibiotics unless the patient has an infection.

What were the main results of the review?

We searched for randomized controlled trials (RCTs; clinical studies where people are randomly put into one of two or more treatment groups) comparing antibiotics with another treatment or a dummy treatment. We found 12 RCTs including 847 participants. The trials involved people of all ages; use different types and doses of antibiotics; and antibiotics taken as tablets, injections or in any other way. The main findings of our review are as follows.

1. Antibiotics, when added to standard therapies, are no different from placebo in the inability to achieve remission or improve disease symptoms in people with UC when given are measured up to three months after taking them.

2. Antibiotics are probably less unsuccessful than placebo in achieving remission or some improvement in UC symptoms measured at 12 months after taking them.

3. In terms of safety, antibiotics may be similar to placebo, but the evidence is low certainty.

4. We don’t know exactly how antibiotics compare to other treatments because there isn’t enough solid evidence to make a judgment.

Conclusion

There is no difference between antibiotics and placebo when added to standard therapies to achieve short-term remission or symptom improvement. However, they may help reduce the number of people who do not achieve remission, and they probably lead to a decrease in the number of people who have not achieved symptom improvement at 12 months.

No conclusions can be drawn about other treatments or their safety due to lack of evidence, although antibiotics may be as safe as placebo. Further research would be needed to clarify the usefulness of antibiotics in the treatment of UC; however, these studies should focus on longer-term outcomes given the findings of this review.

How up-to-date is this review?

This review is current to December 2021.