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The use of oral antibiotic cocktail in medically refractory paediatric acute severe colitis: a case series

Manal Morgan1, Benjamin Loel2, Ray Lang1

  • 1Department of Paediatric Gastroenterology, Hepatology and Liver Transplant.

European Journal of Gastroenterology & Hepatology
|February 20, 2025
PubMed

Insights

Oral antibiotic combination therapy offers a promising rescue treatment for pediatric acute severe colitis (ASC) that doesn't respond to standard care. This approach may help avoid or delay colectomy in children with severe inflammatory bowel disease.

Area of Science:

  • Gastroenterology
  • Pediatric Inflammatory Bowel Disease
  • Microbiome Research

Background:

  • Pediatric acute severe colitis (ASC) is a critical condition with significant long-term implications for inflammatory bowel disease (IBD) outcomes.
  • Conventional medical therapy (CMT) can fail in some pediatric ASC cases, necessitating alternative treatments.
  • Identifying effective rescue therapies is crucial for improving outcomes in medically refractory ASC.

Purpose of the Study:

  • To evaluate the efficacy of oral antibiotic combination therapy as a rescue strategy for pediatric ASC patients unresponsive to CMT.
  • To assess the impact of this therapy on clinical, biochemical, and imaging markers of disease activity.
  • To determine the colectomy rates in children receiving oral antibiotic combination therapy for refractory ASC.

Main Methods:

  • Retrospective analysis of pediatric ASC cases treated with oral antibiotics (vancomycin, amoxicillin, metronidazole, doxycycline) between January 2020 and January 2023.
  • Data collection included Paediatric Ulcerative Colitis Activity Index (PUCAI), albumin, C-reactive protein (CRP), and intestinal ultrasound (IUS) findings.
  • Colectomy rates (acute and deferred) were analyzed as primary outcomes.

Main Results:

  • Oral antibiotic combination therapy was administered in 12 ASC episodes across 11 children post-CMT failure.
  • Significant improvements were observed in PUCAI scores (mean difference -27.86, P < 0.001), albumin, and CRP levels.
  • Intestinal ultrasound showed improvements in bowel wall thickening and vascularity in 5 of 7 patients. Five children avoided colectomy during a median follow-up of 24 months.

Conclusions:

  • Oral antibiotic combination therapy demonstrates potential in deferring or preventing colectomy in pediatric ASC cases refractory to medical treatment.
  • This therapeutic approach shows promise for managing severe, treatment-resistant colitis in children.
  • Further investigation in larger cohorts is warranted to confirm these findings and establish optimal treatment protocols.
Abstract

Keywords:
PRASCOacute severe colitisantibiotics colectomybiologicsinflammatory bowel diseaseinfliximabpaediatrics

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