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

Abstract

Objective: Paediatric acute severe colitis (ASC) is a life-threatening gastroenterological emergency and a predictor of poor long-term inflammatory bowel disease outcomes. We report our experience with oral antibiotic combination therapy as rescue therapy for children with ASC failing to respond to conventional medical therapy (CMT).

Methods: We analysed data of children admitted with ASC between January 2020 and January 2023 who failed steroids and infliximab and received the oral antibiotic combination therapy (vancomycin, amoxicillin, metronidazole and doxycycline). Treatments and responses including Paediatric Ulcerative Colitis Activity Index (PUCAI), biochemical markers, intestinal ultrasound (IUS) and colectomy rates (acute and deferred) were collated.

Results: Oral antibiotic combination therapy was prescribed in 12 episodes of ASC in 11 children following failure of CMT. Improvements were seen in PUCAI (mean difference = -27.86, 95% confidence interval = -43.43 to -12.28, P < 0.001), albumin (mean: 29.5-33.6) and CRP (mean: 12-4), as well as in IUS (bowel wall thickening, extent of involvement or vascularity in five of seven). Five of 11 children were colectomy free at a maximum follow-up of 24 months. Three children had acute colectomy during index admission and three underwent deferred colectomy at a mean of 4 months.

Conclusion: Oral antibiotic combination therapy shows promise in deferring and, in some cases, averting the need for acute colectomy in medically refractory ASC. This notable finding warrants confirmation in larger studies.