TY - JOUR
T1 - Antibacterial therapies in IBD
T2 - Present and future
AU - Pineton De Chambrun, Guillaume P.
AU - Torres, Joana
AU - Darfeuille-Michaud, Arlette
AU - Colombel, Jean Fred́éric
PY - 2012
Y1 - 2012
N2 - The etiology of IBD is unknown but may relate to an unidentified bacterial pathogen or an aberrant immunological reaction to the gut microbiota. Antibiotics have therefore been proposed as a therapy to induce remission in active disease and to prevent relapse. Although the current data are conflicting, a recent systematic review of randomized controlled trials showed a statistically significant benefit of antibiotics over placebo for active Crohn's disease, perianal Crohn's disease, quiescent Crohn's disease, and active ulcerative colitis. Yet these data have been poorly translated into clinical practice, and the indications for the use of antibiotics remain limited to some specific situations, as described in international guidelines. Recent advances in genetics and molecular biology leading to a better understanding of microbial-innate immune interactions in IBD, and increasing evidence establishing a definitive role for the gut flora in the initiation and perpetuation of chronic intestinal inflammation, provide compelling endorsement for new therapeutic interventions using antibiotics. Future clinical trials of antibiotics in IBD should select or stratify patients based on their phenotype, bacteriotype, and perhaps genotype to increase therapeutic efficacy and improve disease outcome. As well as antibiotics, new therapeutic approaches that can modulate/manipulate gut dysbiosis should be also be tested.
AB - The etiology of IBD is unknown but may relate to an unidentified bacterial pathogen or an aberrant immunological reaction to the gut microbiota. Antibiotics have therefore been proposed as a therapy to induce remission in active disease and to prevent relapse. Although the current data are conflicting, a recent systematic review of randomized controlled trials showed a statistically significant benefit of antibiotics over placebo for active Crohn's disease, perianal Crohn's disease, quiescent Crohn's disease, and active ulcerative colitis. Yet these data have been poorly translated into clinical practice, and the indications for the use of antibiotics remain limited to some specific situations, as described in international guidelines. Recent advances in genetics and molecular biology leading to a better understanding of microbial-innate immune interactions in IBD, and increasing evidence establishing a definitive role for the gut flora in the initiation and perpetuation of chronic intestinal inflammation, provide compelling endorsement for new therapeutic interventions using antibiotics. Future clinical trials of antibiotics in IBD should select or stratify patients based on their phenotype, bacteriotype, and perhaps genotype to increase therapeutic efficacy and improve disease outcome. As well as antibiotics, new therapeutic approaches that can modulate/manipulate gut dysbiosis should be also be tested.
UR - http://www.scopus.com/inward/record.url?scp=84863840680&partnerID=8YFLogxK
M3 - Review article
AN - SCOPUS:84863840680
SN - 1466-7401
VL - 12
SP - 89
EP - 101
JO - Inflammatory Bowel Disease Monitor
JF - Inflammatory Bowel Disease Monitor
IS - 3
ER -