Effects of antibiotic therapy in primary sclerosing cholangitis with and without inflammatory bowel disease: a systematic review and meta-analysis

Ayesha Shah; Darrel Crawford; Daniel Burger; Neal Martin; Marjorie Walker; Nicholas J. Talley; Caroline Tallis; Michael Jones; Katherine Stuart; Simon Keely; Peter Lewindon; Graeme A. Macdonald; Mark Morrison; Gerald J. Holtmann

doi:10.1055/s-0039-1688501

Effects of antibiotic therapy in primary sclerosing cholangitis with and without inflammatory bowel disease: a systematic review and meta-analysis

Ayesha Shah, Darrel Crawford, Daniel Burger, Neal Martin, Marjorie Walker, Nicholas J. Talley, Caroline Tallis, Michael Jones, Katherine Stuart, Simon Keely, Peter Lewindon, Graeme A. Macdonald, Mark Morrison, Gerald J. Holtmann^*

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

24 Citations (Scopus)

Abstract

The authors conducted a systematic review and meta-analysis to assess the effect of antibiotic therapy in primary sclerosing cholangitis (PSC). Effect of antibiotic therapy on Mayo PSC Risk Score (MRS), serum alkaline phosphatase (ALP), total serum bilirubin (TSB), and adverse events (AEs) rates were calculated and expressed as standardized difference of means or proportions. Five studies including 124 PSC patients who received antibiotics were included. Overall, antibiotic treatment was associated with a statistically significant reduction in ALP, MRS, and TSB by 33.2, 36.1, and 28.8%, respectively. ALP reduction was greatest for vancomycin (65.6%, p < 0.002) and smallest with metronidazole (22.7%, p = 0.18). Overall, 8.9% (95% confidence interval: 3.9-13.9) of patients had AEs severe enough to discontinue antibiotic therapy. In PSC patients, antibiotic treatment results in a significant improvement in markers of cholestasis and MRS. Antibiotics, particularly vancomycin, may have a positive effect on PSC either via direct effects on the microbiome or via host-mediated mechanisms.

Original language	English
Pages (from-to)	432-441
Number of pages	10
Journal	Seminars in Liver Disease
Volume	39
Issue number	4
DOIs	https://doi.org/10.1055/s-0039-1688501
Publication status	Published - Nov 2019

Keywords

vancomycin
antibiotics
primary sclerosing cholangitis
inflammatory bowel disease
ulcerative colitis
Crohn’s disease
microbiome
Crohn's disease

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Shah, A., Crawford, D., Burger, D., Martin, N., Walker, M., Talley, N. J., Tallis, C., Jones, M., Stuart, K., Keely, S., Lewindon, P., Macdonald, G. A., Morrison, M., & Holtmann, G. J. (2019). Effects of antibiotic therapy in primary sclerosing cholangitis with and without inflammatory bowel disease: a systematic review and meta-analysis. Seminars in Liver Disease, 39(4), 432-441. https://doi.org/10.1055/s-0039-1688501

Shah, Ayesha ; Crawford, Darrel ; Burger, Daniel ; Martin, Neal ; Walker, Marjorie ; Talley, Nicholas J. ; Tallis, Caroline ; Jones, Michael ; Stuart, Katherine ; Keely, Simon ; Lewindon, Peter ; Macdonald, Graeme A. ; Morrison, Mark ; Holtmann, Gerald J. / Effects of antibiotic therapy in primary sclerosing cholangitis with and without inflammatory bowel disease : a systematic review and meta-analysis. In: Seminars in Liver Disease. 2019 ; Vol. 39, No. 4. pp. 432-441.

@article{1d8a1c2f8b82451ab3c4380b65110766,

title = "Effects of antibiotic therapy in primary sclerosing cholangitis with and without inflammatory bowel disease: a systematic review and meta-analysis",

abstract = "The authors conducted a systematic review and meta-analysis to assess the effect of antibiotic therapy in primary sclerosing cholangitis (PSC). Effect of antibiotic therapy on Mayo PSC Risk Score (MRS), serum alkaline phosphatase (ALP), total serum bilirubin (TSB), and adverse events (AEs) rates were calculated and expressed as standardized difference of means or proportions. Five studies including 124 PSC patients who received antibiotics were included. Overall, antibiotic treatment was associated with a statistically significant reduction in ALP, MRS, and TSB by 33.2, 36.1, and 28.8%, respectively. ALP reduction was greatest for vancomycin (65.6%, p < 0.002) and smallest with metronidazole (22.7%, p = 0.18). Overall, 8.9% (95% confidence interval: 3.9-13.9) of patients had AEs severe enough to discontinue antibiotic therapy. In PSC patients, antibiotic treatment results in a significant improvement in markers of cholestasis and MRS. Antibiotics, particularly vancomycin, may have a positive effect on PSC either via direct effects on the microbiome or via host-mediated mechanisms.",

keywords = "vancomycin, antibiotics, primary sclerosing cholangitis, inflammatory bowel disease, ulcerative colitis, Crohn{\textquoteright}s disease, microbiome, Crohn's disease",

author = "Ayesha Shah and Darrel Crawford and Daniel Burger and Neal Martin and Marjorie Walker and Talley, {Nicholas J.} and Caroline Tallis and Michael Jones and Katherine Stuart and Simon Keely and Peter Lewindon and Macdonald, {Graeme A.} and Mark Morrison and Holtmann, {Gerald J.}",

year = "2019",

month = nov,

doi = "10.1055/s-0039-1688501",

language = "English",

volume = "39",

pages = "432--441",

journal = "Seminars in Liver Disease",

issn = "0272-8087",

publisher = "Thieme Medical Publishers",

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Shah, A, Crawford, D, Burger, D, Martin, N, Walker, M, Talley, NJ, Tallis, C, Jones, M, Stuart, K, Keely, S, Lewindon, P, Macdonald, GA, Morrison, M & Holtmann, GJ 2019, 'Effects of antibiotic therapy in primary sclerosing cholangitis with and without inflammatory bowel disease: a systematic review and meta-analysis', Seminars in Liver Disease, vol. 39, no. 4, pp. 432-441. https://doi.org/10.1055/s-0039-1688501

Effects of antibiotic therapy in primary sclerosing cholangitis with and without inflammatory bowel disease : a systematic review and meta-analysis. / Shah, Ayesha; Crawford, Darrel; Burger, Daniel; Martin, Neal; Walker, Marjorie; Talley, Nicholas J.; Tallis, Caroline; Jones, Michael; Stuart, Katherine; Keely, Simon; Lewindon, Peter; Macdonald, Graeme A.; Morrison, Mark; Holtmann, Gerald J.

In: Seminars in Liver Disease, Vol. 39, No. 4, 11.2019, p. 432-441.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - Effects of antibiotic therapy in primary sclerosing cholangitis with and without inflammatory bowel disease

T2 - a systematic review and meta-analysis

AU - Shah, Ayesha

AU - Crawford, Darrel

AU - Burger, Daniel

AU - Martin, Neal

AU - Walker, Marjorie

AU - Talley, Nicholas J.

AU - Tallis, Caroline

AU - Jones, Michael

AU - Stuart, Katherine

AU - Keely, Simon

AU - Lewindon, Peter

AU - Macdonald, Graeme A.

AU - Morrison, Mark

AU - Holtmann, Gerald J.

PY - 2019/11

Y1 - 2019/11

N2 - The authors conducted a systematic review and meta-analysis to assess the effect of antibiotic therapy in primary sclerosing cholangitis (PSC). Effect of antibiotic therapy on Mayo PSC Risk Score (MRS), serum alkaline phosphatase (ALP), total serum bilirubin (TSB), and adverse events (AEs) rates were calculated and expressed as standardized difference of means or proportions. Five studies including 124 PSC patients who received antibiotics were included. Overall, antibiotic treatment was associated with a statistically significant reduction in ALP, MRS, and TSB by 33.2, 36.1, and 28.8%, respectively. ALP reduction was greatest for vancomycin (65.6%, p < 0.002) and smallest with metronidazole (22.7%, p = 0.18). Overall, 8.9% (95% confidence interval: 3.9-13.9) of patients had AEs severe enough to discontinue antibiotic therapy. In PSC patients, antibiotic treatment results in a significant improvement in markers of cholestasis and MRS. Antibiotics, particularly vancomycin, may have a positive effect on PSC either via direct effects on the microbiome or via host-mediated mechanisms.

AB - The authors conducted a systematic review and meta-analysis to assess the effect of antibiotic therapy in primary sclerosing cholangitis (PSC). Effect of antibiotic therapy on Mayo PSC Risk Score (MRS), serum alkaline phosphatase (ALP), total serum bilirubin (TSB), and adverse events (AEs) rates were calculated and expressed as standardized difference of means or proportions. Five studies including 124 PSC patients who received antibiotics were included. Overall, antibiotic treatment was associated with a statistically significant reduction in ALP, MRS, and TSB by 33.2, 36.1, and 28.8%, respectively. ALP reduction was greatest for vancomycin (65.6%, p < 0.002) and smallest with metronidazole (22.7%, p = 0.18). Overall, 8.9% (95% confidence interval: 3.9-13.9) of patients had AEs severe enough to discontinue antibiotic therapy. In PSC patients, antibiotic treatment results in a significant improvement in markers of cholestasis and MRS. Antibiotics, particularly vancomycin, may have a positive effect on PSC either via direct effects on the microbiome or via host-mediated mechanisms.

KW - vancomycin

KW - antibiotics

KW - primary sclerosing cholangitis

KW - inflammatory bowel disease

KW - ulcerative colitis

KW - Crohn’s disease

KW - microbiome

KW - Crohn's disease

UR - http://www.scopus.com/inward/record.url?scp=85073580941&partnerID=8YFLogxK

U2 - 10.1055/s-0039-1688501

DO - 10.1055/s-0039-1688501

M3 - Review article

C2 - 31315136

VL - 39

SP - 432

EP - 441

JO - Seminars in Liver Disease

JF - Seminars in Liver Disease

SN - 0272-8087

IS - 4

ER -

Effects of antibiotic therapy in primary sclerosing cholangitis with and without inflammatory bowel disease: a systematic review and meta-analysis

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