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Empiric Antibiotic Use With Rescue Infliximab Does Not Improve Outcomes in Acute Severe Ulcerative Colitis: A

Kofi Clarke1, Dominic Amakye2, Jiqing Shi3

  • 1Department of Medicine, Division of Gastroenterology and Hepatology Penn State College of Medicine Hershey Pennsylvania USA.

Health Science Reports
|August 13, 2025
PubMed
Abstract

Insights

Concurrent antibiotics with infliximab for acute severe ulcerative colitis (ASUC) offer no surgical or mortality benefits. This practice may increase healthcare utilization, including emergency and critical care services.

Area of Science:

  • Gastroenterology
  • Clinical Pharmacology
  • Health Services Research

Background:

  • Acute severe ulcerative colitis (ASUC) management sometimes includes antibiotics to treat presumed infections.
  • The clinical benefit of concurrent antibiotic use with infliximab in ASUC is not well-established.
  • This study investigates the efficacy and outcomes of this common clinical practice.

Purpose of the Study:

  • To evaluate the impact of concurrent antibiotic administration with infliximab rescue therapy in hospitalized ASUC patients.
  • To determine if antibiotic use improves outcomes such as surgery, colectomy, sepsis, or mortality.
  • To assess the association between concurrent antibiotic use and healthcare utilization.

Main Methods:

  • Retrospective cohort study utilizing the TriNetX US Collaborative Network.
  • Comparison of hospitalized ASUC patients receiving infliximab with and without concurrent antibiotics.
  • Propensity score matching to balance baseline characteristics, followed by Kaplan-Meier analyses and hazard ratio calculations.

Main Results:

  • Concurrent antibiotics with infliximab did not improve outcomes for IBD-related surgery, colectomy, sepsis, or mortality.
  • Hazard ratios for surgery, colectomy, sepsis, and mortality were not significantly improved with antibiotic use.
  • The antibiotic cohort showed increased utilization of emergency department and critical care services.

Conclusions:

  • Empiric antibiotic administration with infliximab rescue therapy in ASUC does not enhance patient outcomes.
  • Concurrent antibiotic use in ASUC may be linked to increased healthcare resource utilization.
  • Clinical guidelines should reconsider the routine use of antibiotics in this setting.
Keywords:
concurrent treatmenthealth care utilizationhospitalizationinfliximab

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