Area Editoriale
Una combinazione di tre antibiotici si dimostra moderatamente efficace nell'eradicare l'infezione di Fusobacterium Varium e marginalmente efficace nel trattamento della colite ulcerosa attiva. ipotesi suggestiva, ma sarebbero ovviamente necessari dati più solidi
Ohkusa T, Kato K, Terao S, Chiba T, Mabe K, Murakami K, Mizokami Y, Sugiyama T, Yanaka A, Takeuchi Y, Yamato S, Yokoyama T, Okayasu I, Watanabe S, Tajiri H, Sato N; Japan UC Antibiotic Therapy Study Group.Newly developed antibiotic combination therapy for ulcerative colitis: a ouble-blind placebo-controlled multicenter trial. Am J Gastroenterol. 2010;105:1820-9
OBJECTIVES: Fusobacterium varium may contribute to ulcerative colitis (UC). We onducted a double-blind placebo-controlled multicenter trial to determine hether antibiotic combination therapy induces and/or maintains remission of ctive UC. METHODS: Patients with chronic mild-to-severe relapsing UC were andomly assigned to oral amoxicillin 1500 mg/day, tetracycline 1500 mg/day, and metronidazole 750 mg/day, vs. placebo, for 2 weeks, and then followed up. The rimary study end point was clinical response (Mayo score at 3 months after reatment completion) and secondary end points were clinical and endoscopic score mprovements at 12 months. Anti-F. varium antibodies were measured by ezyme-linked immunosorbent assay. RESULTS: Treatment and placebo groups each had 05 subjects. At the primary end point, response rates were significantly greater ith antibiotics than with placebo (44.8 vs. 22.8%, P=0.0011). Endoscopic scores significantly improved at 3 months (P=0.002 vs. placebo). Remission rates were 9.0% (antibiotics) vs. 15.8% (placebo) at 3 months (P=0.59). At the secondary end point, response rates were significantly greater with antibiotics than with lacebo (49.5 vs. 21.8%, respectively, P<0.0001). Endoscopic scores were significantly improved at 12 months after antibiotic treatment (P=0.002 vs. placebo). Remission rates had improved to 26.7% with antibiotics vs. 14.9% for
placebo, at 12 months (P=0.041). F. varium antibody titers decreased in
responders but not in nonresponders, and more in the antibiotic than in the placebo group. More pretreatment steroid-dependent UC patients discontinued corticosteroids after treatment completion (6 months: 28.6 vs. 11.8%, respectively, P=0.046; 9 months: 34.7 vs. 13.7%, respectively, P=0.019; and 12 months: 34.7 vs. 13.7%, respectively, P=0.019). These effects were greater in the subanalysis of the active group (Mayo scores of 6-12) than in that of total cases (0-12). No serious drug-related toxicities occurred. CONCLUSIONS: The 2-week triple antibiotic therapy produced improvement, remission, and steroid withdrawal in active UC more effectively than a placebo.