Antibiotics and inflammatory bowel diseases

Area of Science:

• Gastroenterology
• Microbiology
• Pharmacology

Background:

• Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis, are linked to gut microbiota dysbiosis.
• Antibiotic use has been associated with CD onset, but not ulcerative colitis.
• The role of Mycobacterium avium subspecies paratuberculosis (MAP) in CD etiology remains unconfirmed.

Purpose of the Study:

• To evaluate the role of intestinal microbiota in CD pathogenesis.
• To assess the therapeutic efficacy of antibiotics in managing CD.
• To explore the potential of locally acting antibiotics for CD treatment.

Main Methods:

• Review of existing data on antibiotic use and IBD.
• Analysis of studies investigating the link between MAP and CD.
• Examination of clinical practice and research on antibiotic therapy for CD flares and postoperative recurrence.

Main Results:

• Current data do not strongly support the general therapeutic benefit of antibiotics for CD.
• Controversy exists regarding antibiotic use for acute CD flares and postoperative recurrence.
• A subgroup of CD patients (colonic involvement, early disease, inflammation markers) may respond better to antibiotics.

Conclusions:

• The rationale for antibiotic use in CD stems from the role of gut microbiota.
• Long-term antibiotic use is associated with significant side effects.
• Locally acting antibiotics represent a promising therapeutic strategy for CD.