| 特集名 | IBDの最近の治療 | |
|---|---|---|
| 題名 | その他の治療法 (1) 潰瘍性大腸炎における抗菌薬多剤併用療法 | |
| 発刊年月 | 2012年 01月 | |
| 著者 | 大草 敏史 | 東京慈恵会医科大学附属柏病院消化器・肝臓内科 |
| 著者 | 月永 真太郎 | 東京慈恵会医科大学附属柏病院消化器・肝臓内科 |
| 著者 | 小田原 俊一 | 東京慈恵会医科大学附属柏病院消化器・肝臓内科 |
| 著者 | 三戸部 慈実 | 東京慈恵会医科大学附属柏病院消化器・肝臓内科 |
| 著者 | 高原 映崇 | 東京慈恵会医科大学附属柏病院消化器・肝臓内科 |
| 著者 | 内山 幹 | 東京慈恵会医科大学附属柏病院消化器・肝臓内科 |
| 著者 | 荒川 廣志 | 東京慈恵会医科大学附属柏病院消化器・肝臓内科 |
| 著者 | 小井戸 薫雄 | 東京慈恵会医科大学附属柏病院消化器・肝臓内科 |
| 【 要旨 】 | 潰瘍性大腸炎（UC）に対して抗菌薬多剤併用ATM療法（アモキシシリン＋テトラサイクリン＋メトロニダゾール）を開発し，RCTを施行，抗菌薬投与群で，症状，内視鏡所見，病理所見ともに有意な改善がみられ，再発率も低下していた．難治性のステロイド依存性，抵抗性UC についても同様に有効であった．さらに，多施設共同二重盲検試験にて200例余の症例で検討したところ，プラセボと比べ有意に高い症状・内視鏡所見の改善が得られ，寛解導入率も高かった．以上の3試験において重篤な副作用もなかった．以上から，抗菌薬多剤併用ATM療法はUCに対する有望な新治療法と考えられた． | |
| Theme | Current Therapy of IBD | |
|---|---|---|
| Title | Effectiveness of Antibiotic Combination Therapy for Ulcerative Colitis | |
| Author | Toshifumi Ohkusa | Department of Gastroenterology and Hepatology, Jikei University Kashiwa Hospital |
| Author | Shintaro Tsukinaga | Department of Gastroenterology and Hepatology, Jikei University Kashiwa Hospital |
| Author | Shunichi Odawara | Department of Gastroenterology and Hepatology, Jikei University Kashiwa Hospital |
| Author | Jimi Mitobe | Department of Gastroenterology and Hepatology, Jikei University Kashiwa Hospital |
| Author | Eishu Takahara | Department of Gastroenterology and Hepatology, Jikei University Kashiwa Hospital |
| Author | Kan Uchiyama | Department of Gastroenterology and Hepatology, Jikei University Kashiwa Hospital |
| Author | Hiroshi Arakawa | Department of Gastroenterology and Hepatology, Jikei University Kashiwa Hospital |
| Author | Shigeo Koido | Department of Gastroenterology and Hepatology, Jikei University Kashiwa Hospital |
| [ Summary ] | We previously reported that Fusobacterium varium (F. varium) may be a pathogenic factor in relation to ulcerative colitis (UC). We also reported that antibiotic combination therapy against F. varium is effective for active UC treatment. We assess whether antibiotic combination therapy iseffective for induction and maintenance of remission of UC. Patients received amoxicillin 500 mg tds, tetracycline 500 mg tds and metronidazole 250 mg tdsfor two weeks. We selected these three antibiotics because F. varium was sensitive to some antibiotics. Sulfasalazine, 5-aminosalicylic acid, prednisolone and/or probioticsbeing taken in stable doses for set time periods prior to study inclusion were continued. Symptom assessment and colonoscopic evaluations were performed in a blind manner before enrollment, and at 3 and 12 months after treatment. 1) Twenty chronic, active UC patientswith F. varium infection were enrolled consecutively and were randomly assigned to receive amoxicillin, tetracycline or metronidazole per osfor 2 weeks (treatment group ; n=10), or no antibiotics (control group ; n=10). 2) We enrolled 61 steroid-dependent active UC patients (median age 36, range, 16-73 years, male/female : 41/20) whose relapse had occurred during tapering of prednisolone below 15 mg/day and who were unable to be weaned off steroids without clinical relapse. 3) Patients with active UC were enrolled consecutively, and randomly assigned to receive amoxicillin, tetracycline and metronidazole per os for 2 weeks (treatment group ; n=105) or placebo (control group；n=101). In the above three long-term follow-up studies, twoweek antibiotic combination therapy waseffective and safe in patientswith active ulcerative colitis. |
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