Antibiotics and probiotics in treatment of inflammatory bowel disease

Table 1 Suggested mechanisms of action of antibiotics and probiotics

Antibiotics	Probiotics
Eradication of bacterial antigenic triggers	Inhibition of pathogenic enteric bacteria by:
Elimination of bacterial overgrowth	decreasing luminal pH
Reduction of pro-inflammatory bacterial toxins	secretion of bacteriocidal proteins
Potential immunosuppressive properties of antibiotics	resisting colonization
	blocking epithelial binding
	Improvement in epithelial and mucosal barrier function by:
	production of short-chain fatty acids
	enhancing mucus production
	increasing barrier integrity
	Alteration of immunoregulation by:
	increasing interleukin-10 and TGFβ, and decreasing TNF levels
	increasing IgA production

Table 2 Antibiotics trials in active Crohn’s disease

Study	Patients (n)	wk	Main outcome	Study design	Treatment schedules
Blichfeldt et al[28]	22	8	Improvement (clinical/lab score)	DB crossover study	MZ (+ SASP/CS) Placebo (+ SASP/CS)
Ursing et al[29]	22	16	Change in CDAI and orosomucoid	DB crossover study	MZ SASP
Ambrose et al[30]	72	4	Improvement (Clinical/lab.score)	DB RCT	MZ CO, MZ/CO, placebo
Sutherland et al[31]	99	16	Change in CDAI from baseline	DR RCT	MZ (10/20 mg/kg) Placebo
Prantera et al[32]	41	12	Clinical remission (CDAI < 150)	NB RCT	MZ + Cipro Steroids
Colombel et al[34]	40	6	Clinical remission (CDAI < 150)	NB RCT	CIPRO 5-ASA
Arnold et al[35]	47	24	Change in CDAI	NB RCT	CIPRO (+ conc drugs) Placebo (+ conc drugs)
Steinhart et al[33]	134	8	Clinical remission (CDAI < 150)	DB RCT	MZ+CIPRO (+ bud 9 mg) Placebo (+ bud. 9 mg)

CDAI: Crohn’s disease activity index.

Table 3 Organisms associated with probiotic activity

Most commonly	Other bacterial strains	Yeast
Lactobacilli	Enterococci	Saccharomyces boulardii
Bifidobacteria	Non-pathogenic E. coli
Streptococci