The inflammatory bowel diseases, Crohn's and ulcerative colitis, have been treated with a range of antibiotics for inducing and maintaining remission, as well as the prevention of post-operative symptoms. To date, many studies have been performed assessing the efficacy of antibiotics when used alone, in combination with other antibiotics, or as an adjunctive therapy to other pharmaceutical treatments. Literature evidence supporting the use of antibiotics in IBD can be ambiguous, especially when considering the potential role of dysbiosis in the gastrointestinal tract. The review considers the systemic effect of antibiotics and the evidence base for their efficacy in the treatment of IBD.

1.
Marshall BJ, Goodwin CS, Warren JR, et al: Prospective double-blind trial of duodenal ulcer relapse after eradication of Campylobacter pylori. Lancet 1988;2:1437-1442.
2.
Marshall BJ, Warren JR: Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984;1:1311-1315.
3.
Strachan DP: Hay fever, hygiene, and household size. BMJ 1989;299:1259-1260.
4.
Wang ZK, Yang YS, Chen Y, et al: Intestinal microbiota pathogenesis and fecal microbiota transplantation for inflammatory bowel disease. World J Gastroenterol 2014;20:14805-14820.
5.
Missaghi B, Barkema HW, Madsen KL, et al: Perturbation of the human microbiome as a contributor to inflammatory bowel disease. Pathogens 2014;3:510-527.
6.
Ghouri YA, Richards DM, Rahimi EF, et al: Systematic review of randomized controlled trials of probiotics, prebiotics, and synbiotics in inflammatory bowel disease. Clin Exp Gastroenterol 2014;7:473-487.
7.
Shen J, Zuo ZX, Mao AP: Effect of probiotics on inducing remission and maintaining therapy in ulcerative colitis, Crohn's disease, and pouchitis: meta-analysis of randomized controlled trials. Inflamm Bowel Dis 2014;20:21-35.
8.
Avershina E, Rudi K: Confusion about the species richness of human gut microbiota. Benef Microbes 2015;6:657-659.
9.
Suhr MJ, Hallen-Adams HE: The human gut mycobiome: pitfalls and potentials-a mycologist's perspective. Mycologia 2015;pii:15-147.
10.
Thompson GR, Trexler PC: Gastrointestinal structure and function in germ-free or gnotobiotic animals. Gut 1971;12:230-235.
11.
Machiels K, Joossens M, Sabino J, et al: A decrease of the butyrate-producing species Roseburia hominis and Faecalibacterium prausnitzii defines dysbiosis in patients with ulcerative colitis. Gut 2014;63:1275-1283.
12.
Baumgart M, Dogan B, Rishniw M, et al: Culture independent analysis of ileal mucosa reveals a selective increase in invasive Escherichia coli of novel phylogeny relative to depletion of Clostridiales in Crohn's disease involving the ileum. ISME J 2007;1:403-418.
13.
Wright EK, Kamm MA, Teo SM, et al: Recent advances in characterizing the gastrointestinal microbiome in Crohn's disease: a systematic review. Inflamm Bowel Dis 2015;21:1219-1228.
14.
Coyte KZ, Schluter J, Foster KR: The ecology of the microbiome: networks, competition, and stability. Science 2015;350:663-666.
15.
Bhan AK, Mizoguchi E, Smith RN, et al: Colitis in transgenic and knockout animals as models of human inflammatory bowel disease. Immunol Rev 1999;169:195-207.
16.
Young VB, Raffals LH, Huse SM, et al: Multiphasic analysis of the temporal development of the distal gut microbiota in patients following ileal pouch anal anastomosis. Microbiome 2013;1:9.
17.
Russell SL, Gold MJ, Hartmann M, et al: Early life antibiotic-driven changes in microbiota enhance susceptibility to allergic asthma. EMBO Rep 2012;13:440-447.
18.
Shaw SY, Blanchard JF, Bernstein CN: Association between the use of antibiotics and new diagnoses of Crohn's disease and ulcerative colitis. Am J Gastroenterol 2011;106:2133-2142.
19.
Ungaro R, Bernstein CN, Gearry R, et al: Antibiotics associated with increased risk of new-onset Crohn's disease but not ulcerative colitis: a meta-analysis. Am J Gastroenterol 2014;109:1728-1738.
20.
Virta L, Auvinen A, Helenius H, et al: Association of repeated exposure to antibiotics with the development of pediatric Crohn's disease - a nationwide, register-based Finnish case-control study. Am J Epidemiol 2012;175:775-784.
21.
Khan KJ, Ullman TA, Ford AC, et al: Antibiotic therapy in inflammatory bowel disease: a systematic review and meta-analysis. Am J Gastroenterol 2011;106:661-673.
22.
Ohkusa T, Nomura T, Terai T, et al: Effectiveness of antibiotic combination therapy in patients with active ulcerative colitis: a randomized, controlled pilot trial with long-term follow-up. Scand J Gastroenterol 2005;40:1334-1342.
23.
Dickinson RJ, O'Connor HJ, Pinder I, et al: Double blind controlled trial of oral vancomycin as adjunctive treatment in acute exacerbations of idiopathic colitis. Gut 1985;26:1380-1384.
24.
Turunen UM, Farkkila MA, Hakala K, et al: Long-term treatment of ulcerative colitis with ciprofloxacin: a prospective, double-blind, placebo-controlled study. Gastroenterology 1998;115:1072-1078.
25.
Arnold GL, Beaves MR, Pryjdun VO, et al: Preliminary study of ciprofloxacin in active Crohn's disease. Inflamm Bowel Dis 2002;8:10-15.
26.
Prantera C, Lochs H, Grimaldi M, et al: Rifaximin-extended intestinal release induces remission in patients with moderately active Crohn's disease. Gastroenterology 2012;142:473-481.
27.
Selby W, Pavli P, Crotty B, et al: Two-year combination antibiotic therapy with clarithromycin, rifabutin, and clofazimine for Crohn's disease. Gastroenterology 2007;132:2313-2319.
28.
Su JW, Ma JJ, Zhang HJ: Use of antibiotics in patients with Crohn's disease: a systematic review and meta-analysis. J Dig Dis 2015;16:58-66.
29.
Steinhart AH, Feagan BG, Wong CJ, et al: Combined budesonide and antibiotic therapy for active Crohn's disease: a randomized controlled trial. Gastroenterology 2002;123:33-40.
30.
Maeda Y, Ng SC, Durdey P, et al: Randomized clinical trial of metronidazole ointment versus placebo in perianal Crohn's disease. Br J Surg 2010;97:1340-1347.
31.
Thia KT, Mahadevan U, Feagan BG, et al: Ciprofloxacin or metronidazole for the treatment of perianal fistulas in patients with Crohn's disease: a randomized, double-blind, placebo-controlled pilot study. Inflamm Bowel Dis 2009;15:17-24.
32.
Dewint P, Hansen BE, Verhey E, et al: Adalimumab combined with ciprofloxacin is superior to adalimumab monotherapy in perianal fistula closure in Crohn's disease: a randomised, double-blind, placebo controlled trial (ADAFI). Gut 2014;63:292-299.
33.
West RL, van der Woude CJ, Hansen BE, et al: Clinical and endosonographic effect of ciprofloxacin on the treatment of perianal fistulae in Crohn's disease with infliximab: a double-blind placebo-controlled study. Aliment Pharmacol Ther 2004;20:1329-1336.
34.
Jigaranu AO, Nedelciuc O, Blaj A, et al: Is rifaximin effective in maintaining remission in Crohn's disease? Dig Dis 2014;32:378-383.
35.
Herfarth HH, Katz JA, Hanauer SB, et al: Ciprofloxacin for the prevention of postoperative recurrence in patients with Crohn's disease: a randomized, double-blind, placebo-controlled pilot study. Inflamm Bowel Dis 2013;19:1073-1079.
36.
Manosa M, Cabre E, Bernal I, et al: Addition of metronidazole to azathioprine for the prevention of postoperative recurrence of Crohn's disease: a randomized, double-blind, placebo-controlled trial. Inflamm Bowel Dis 2013;19:1889-1895.
37.
Doherty G, Bennett G, Patil S, et al: Interventions for prevention of post-operative recurrence of Crohn's disease. Cochrane Database Syst Rev 2009;4:CD006873.
38.
Singh S, Garg SK, Pardi DS, et al: Comparative efficacy of pharmacologic interventions in preventing relapse of Crohn's disease after surgery: a systematic review and network meta-analysis. Gastroenterology 2015;148:64-76.e2; quiz e14.
39.
Mantzaris GJ, Archavlis E, Christoforidis P, et al: A prospective randomized controlled trial of oral ciprofloxacin in acute ulcerative colitis. Am J Gastroenterol 1997;92:454-456.
40.
Mantzaris GJ, Petraki K, Archavlis E, et al: A prospective randomized controlled trial of intravenous ciprofloxacin as an adjunct to corticosteroids in acute, severe ulcerative colitis. Scand J Gastroenterol 2001;36:971-974.
41.
Burke DA, Axon AT, Clayden SA, et al: The efficacy of tobramycin in the treatment of ulcerative colitis. Aliment Pharmacol Ther 1990;4:123-129.
42.
Mantzaris GJ, Hatzis A, Kontogiannis P, et al: Intravenous tobramycin and metronidazole as an adjunct to corticosteroids in acute, severe ulcerative colitis. Am J Gastroenterol 1994;89:43-46.
43.
Gionchetti P, Rizzello F, Ferrieri A, et al: Rifaximin in patients with moderate or severe ulcerative colitis refractory to steroid-treatment: a double-blind, placebo-controlled trial. Dig Dis Sci 1999;44:1220-1221.
44.
Ohkusa T, Kato K, Terao S, et al: Newly developed antibiotic combination therapy for ulcerative colitis: a double-blind placebo-controlled multicenter trial. Am J Gastroenterol 2010;105:1820-1829.
45.
Leiper K, Martin K, Ellis A, et al: Clinical trial: randomized study of clarithromycin versus placebo in active Crohn's disease. Aliment Pharmacol Ther 2008;27:1233-1239.
46.
Prantera C, Lochs H, Campieri M, et al: Antibiotic treatment of Crohn's disease: results of a multicentre, double blind, randomized, placebo-controlled trial with rifaximin. Aliment Pharmacol Ther 2006;23:1117-1125.
47.
Afdhal NH, Long A, Lennon J, et al: Controlled trial of antimycobacterial therapy in Crohn's disease. Clofazimine versus placebo. Dig Dis Sci 1991;36:449-453.
48.
Sutherland L, Singleton J, Sessions J, et al: Double blind, placebo controlled trial of metronidazole in Crohn's disease. Gut 1991;32:1071-1075.
49.
Prantera C, Kohn A, Mangiarotti R, et al: Antimycobacterial therapy in Crohn's disease: results of a controlled, double-blind trial with a multiple antibiotic regimen. Am J Gastroenterol 1994;89:513-518.
50.
Rutgeerts P, Van Assche G, Vermeire S, et al: Ornidazole for prophylaxis of postoperative Crohn's disease recurrence: a randomized, double-blind, placebo-controlled trial. Gastroenterology 2005;128:856-861.
51.
Knoop KA, McDonald KG, Kulkarni DH, Newberry RD: Antibiotics promote inflammation through the translocation of native commensal colonic bacteria. Gut 2015;pii:gutjnl-2014-309059.
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