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 -