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Antibiotic Cocktail for Pediatric Acute Severe Colitis and the Microbiome: The PRASCO Randomized Controlled Trial

Dan Turner1, Jason Bishai2, Leah Reshef3

  • 1Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel.

Inflammatory Bowel Diseases
|December 14, 2019
PubMed

Insights

Quadruple antibiotic therapy combined with intravenous corticosteroids improved acute severe colitis (ASC) in children. This approach showed better disease activity by day 5 compared to IVCS alone, though long-term outcomes require further study.

Area of Science:

  • Gastroenterology
  • Pediatric Inflammatory Bowel Disease
  • Microbiome Research

Background:

  • Inflammatory bowel disease (IBD) is linked to alterations in the gut microbiome.
  • Acute severe colitis (ASC) in children requires effective treatment strategies.
  • This study investigates a quadruple antibiotic cocktail alongside intravenous corticosteroids (IVCS) for ASC.

Purpose of the Study:

  • To evaluate the effectiveness of a quadruple antibiotic cocktail plus IVCS in pediatric ASC.
  • To assess the impact on disease activity and microbiome composition in children with ASC.

Main Methods:

  • A pilot randomized controlled trial involving hospitalized children with ASC (pediatric ulcerative colitis activity index [PUCAI] ≥65).
  • Two arms: IVCS plus antibiotics (amoxicillin, vancomycin, metronidazole, doxycycline/ciprofloxacin) vs. IVCS alone for 14 days.
  • Primary outcome: PUCAI at day 5. Microbiome analysis via 16S rRNA gene and metagenome sequencing.

Main Results:

  • The IVCS plus antibiotics group showed a significantly lower mean day-5 PUCAI (25) compared to the IVCS-only group (40.4) (P = 0.037).
  • Colectomy rates were similar between groups over 1 year (3 vs. 2 children).
  • Decreased microbiome diversity at admission was associated with day-5 response in the IVCS-only arm.

Conclusions:

  • Quadruple antibiotic therapy in addition to IVCS improved disease activity in children with ASC by day 5.
  • ASC is associated with microbiome alterations, including reduced diversity and predominant bacterial species.
  • Larger studies are needed to confirm long-term benefits of this combined therapy.
Abstract

Keywords:
acute severe colitisantibioticspediatriculcerative colitis

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