Download PDF
Semin Liver Dis 2019; 39(04): 432-441
DOI: 10.1055/s-0039-1688501
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effects of Antibiotic Therapy in Primary Sclerosing Cholangitis with and without Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Ayesha Shah   *
1   Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
2   Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
3   Translational Research Institute, Princess Alexandra Hospital, Brisbane, QLD, Australia
,
Darrel Crawford
1   Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
4   Gallipoli Research Foundation, Brisbane, QLD Australia
,
Daniel Burger
1   Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
2   Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
,
Neal Martin
1   Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
2   Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
,
Marjorie Walker   *
5   Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW Australia
,
Nicholas J. Talley   *
5   Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW Australia
,
Caroline Tallis
1   Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
2   Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
,
Michael Jones   *
6   Department of Psychology, Macquarie University, Sydney, NSW, Australia
,
Katherine Stuart
1   Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
2   Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
,
Simon Keely
5   Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW Australia
,
Peter Lewindon
1   Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
7   Lady Cilento Children's Hospital, South Brisbane, QLD, Australia
,
Graeme A. Macdonald
1   Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
2   Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
,
Mark Morrison
8   Department of Microbial Biology and Metagenomics, Diamantina Institute, University of Queensland, Woolloongabba, Brisbane, QLD, Australia
,
Gerald J. Holtmann   *
1   Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
2   Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
3   Translational Research Institute, Princess Alexandra Hospital, Brisbane, QLD, Australia
› Author Affiliations Funding None.
Further Information

Publication History

Publication Date:
17 July 2019 (online)

   Permissions and Reprints
Zoom Image

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's disease - microbiome

Writing Assistance

None.


Authors' Contributions

Ayesha Shah and Gerald Holtmann: Study idea, concept and design, data extraction and interpretation of data, and drafting of the manuscript.


Darrel Crawford: Analysis and interpretation of data, input into the manuscript, and review of final manuscript.


Daniel Burger: Input into discussions and review of final manuscript.


Mark Morrison: Study idea, concept and design, drafting of the manuscript, and review of final manuscript.


Mike Jones: Data analysis and review of final manuscript.


Nicholas Talley: Study idea, data interpretation, drafting of the manuscript and review of final manuscript.


Peter Lewindon: Drafting of the manuscript and review of final manuscript.


Marjorie Walker: Drafting of the manuscript and review of final manuscript.


Katherine Stuart: Drafting of the manuscript and review of final manuscript.


Graeme Macdonald: Drafting of the manuscript and review of final manuscript.


Neal Martin: Drafting of the manuscript and review of final manuscript.


Caroline Tallis: Drafting of the manuscript and review of final manuscript.


Simon Keely: Drafting of the manuscript and review of final manuscript.


* for the Australian Gastrointestinal Research Alliance (AGIRA).


Supplementary Material