Effects of Antibiotic Therapy in Primary Sclerosing Cholangitis with and without Inflammatory Bowel Disease: A Systematic Review and Meta-AnalysisFunding None.
17 July 2019 (online)
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.
Keywordsvancomycin - antibiotics - primary sclerosing cholangitis - inflammatory bowel disease - ulcerative colitis - Crohn's disease - microbiome
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).
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