D Turner et al. Inflamm Bowel Dis 2020; 26: 1733-1742. Antibiotic Cocktail for Pediatric Acute Severe Colitis and the Microbiome: The PRASCO Randomized Controlled Trial

This randomized study with 28 children with acute severe ulcerative colitis (ASUC) (PUCAI > /= 65) tried to determine if antibiotics with IV corticosteroids resulted in improved outcomes compared to IV corticosteroids alone. Most in the antibiotic group received the following for 3 weeks:

• Vancomycin 250 mg 4/day (if less than 8 years, then 125 mg 4/day)
• Amoxicillin 50 mg/kg/day divided into 3/day dosing (max 500 mg/dose)
• Metronidazole 5 mg/kg/dose 3/day (max 250 mg/dose)
• Doxycycline 2 mg/kg/dose 2/day (children less than 7 years rec’d ciprofloxacin 10 mg/kg 2/day -max 250 mg/dose)

Key findings:

• The mean day-5 PUCAI was 25 ± 16.7 in the abx/steroid combination group vs 40.4 ± 20.4 in the steroid monotherapy group (P = 0.037)
• Median calprotectin values were lower in the abx combination group at day 5 (1202 vs. 2170, P=0.24) and at discharge (1210 vs 1840, P=0.695)
• The need for 2nd line rescue therapy was low in both groups: 19% in abx group and 17% in the steroid group
• Within 1 year, 3/16 (19%) in the abx combination group had had a colectomy compared with 2/12 (17%) in the steroid monotherapy.
• The authors found no correlation between microbial features/microbiome at admissioin and clinical response 5 days later

In their discussion, the authors note that if antibiotics had a treatment benefit as high as 30% in avoiding second-line treatment (ie, 14% in intervention arm), “randomization of 1228 children would be required to show such a difference with a power of 80%.”

My take: I agree with the authors who state that “antibiotics cannot be routinely recommended until larger studies demonstrate a reduced need for second-line treatment or colectomy.”

Related blog posts:

• A Little More Data on Antibiotics for Acute Severe Ulcerative Colitis -this blog posts the abstract to this report when it was published online
• Management of Acute Severe Ulcerative Colitis
• Oral Antibiotics For Refractory Inflammatory Bowel Disease | gutsandgrowth
• IBD Reviews: Role of Antibiotics in IBD and Data on Biomarkers
• Management of Pediatric Ulcerative Colitis -ECCO Recommendations

Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician.  Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition