Meta-analysis of broad-spectrum antibiotic therapy in patients with active inflammatory bowel disease

Abstract

Patients with Crohn's disease (CD) or ulcerative colitis (UC) undergo various therapies, including antibiotic therapy. This meta-analysis of controlled clinical trials was conducted to evaluate whether the use of antibacterial therapy improves the clinical symptoms of inflammatory bowel disease (IBD). The Medline and Scopus databases were searched and a systematic review was performed. Randomized, controlled trials in which antibiotic therapy was compared with placebo were investigated. A total of 10 randomized, placebo-controlled clinical trials for CD were included in the meta-analysis. The pooling of the data from these trials yielded an odds ratio (OR) of 1.35 [95% confidence interval (CI), 1.16-1.58] for antibiotic therapy compared with placebo in patients with CD. Furthermore, nine randomized placebo-controlled clinical trials for UC matched our criteria and were included in the analysis. The pooling of the data from these trials yielded an OR of 2.17 (95% CI, 1.54-3.05) in favor of antibiotic therapy. These results suggest that antibiotics improve clinical outcomes in patients with IBD.

Figure 1

Analysis of trials based on the use of antibiotic therapy with or without a tapering course of corticosteroids in Crohn’s disease. RR, risk ratio; CI, confidence interval.

Figure 2

Funnel plot of indicators of bias for the outcome of clinical improvement in studies of antibiotic therapy for Crohn’s disease. RR, risk ratio.

Figure 3

Individual and pooled odds ratios (ORs) for clinical remission in studies that considered antibiotic therapy in ulcerative colitis. CI, confidence interval.

Figure 4

Funnel plot of indicators of bias for the outcome of clinical improvement in studies of antibiotic therapy for ulcerative colitis. OR, odds ratio; CI, confidence interval.