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Triple ABX for UC??

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Posted 5/1/2016 3:16 AM (GMT 0)
Jared asked a question about Triple ABX for Crohn's, and if it might help UC - I became curious about triple abx for UC. If anyone had tried to treat UC with multiple antibiotics before as part of a study. What popped up was a few older studies. Surprised me.

From 2010:
Newly developed antibiotic combination therapy for ulcerative colitis: a double-blind placebo-controlled multicenter trial. www.ncbi.nlm.nih.gov/pubmed?term=20216533

From 2014
Combination of oral antibiotics may be effective in severe pediatric ulcerative colitis: a preliminary report.
www.ncbi.nlm.nih.gov/pubmed?term=24958064

It seems as though the first has been discussed on here before, not sure about the second. I was just curious if anyone ever tried either of these therapies. Would be interesting if group member had. I'd really like to know what came about from the pediatric study - if they continued with further studies or just ran into a dead end.

Makes me wonder if like in Crohn's these short term 2 week type courses are simply not enough. I wonder about long term like in the new Crohn's triple ABX regimen.

I know many blame ABX for their onset though.
Posted 5/1/2016 5:48 AM (GMT 0)
huh... I guess a few people found remission from this and posted on here long ago. Was from before my time on here. Anyone tried this recently?

The first study used a combo of: "amoxicillin 1500 mg/day, tetracycline 1500 mg/day, and metronidazole 750 mg/day"

The second study used a combo of: "metronidazole, amoxicillin, doxycycline, and if during hospital admission, also vancomycin"

Still curious and looking to see if there was a follow up study on the pediatric one

Post Edited (Canada Mark) : 4/30/2016 11:51:56 PM (GMT-6)

Posted 5/1/2016 10:40 AM (GMT 0)
Here is a meta analysis,for UC not great but helps some people.
Even on healingwell there has been some success for UC but not too many.
Might depend on which antibiotics and for how long.
Certain antibiotic are also anti inflammatory.
What I suspect goes on is that a reduction of commensal bacterial load may allow in some
cases the mucosa to have a better chance of healing.
But getting to the bacteria in the mucosal biofilm is difficult.
We can see from Swidniski's (SP) work that even on an antibiotic there is a strong
mucosal biofilm.
about 5 years ago I was on Cipro for 37 days, no effect on the UC.
It was a none bacterial prostate problem.
The doc's have tried, but as you can see from the meta analysis, the authors are not
happy with the design of some of the trials.
Old Mike

www.ncbi.nlm.nih.gov/pmc/articles/PMC3494118/
Posted 5/1/2016 1:28 PM (GMT 0)
That being said here is some other stuff going on.
Heme from red meat. Looks like if you are going paleo eat fish or chicken or low heme meat.
Cant be the whole story though since we also know that vegetarians get UC.
Hydrogen sulfide breaks mucus disulfide bonds.
Bi****h (b I s m u t h)compounds reduce hydrogen sulfide in the colon yet
they do not really put UC into remission, nor does rectal bi****h carbomer which has
been tried, with not outstanding results.
Hydrogen sulfide has been implicated in UC for say the last 20-30 years, I often
talk about SRB's and sulfur farts.
I think the early trials showed that it worked in enema form but the later carbomer trials not so good.
Lots of stuff to digest(pun intended) from the first paper.

Old Mike
see figure 5 for a possible UC mechanism
heme make these grow which are mucolytic
Notably, the abundance of the mucin-degrading Akkermansia muciniphila was eightfold increased by heme,
SRB's produce hydrogen sulfide, which degrades the disulfide mucus bonds, mucus is busted
heme is also cytotoxic to colon cells. Bacteria get to the mucosa, inflammation starts
real mess
www.pnas.org/content/112/32/10038.full?sid=572f8954-ea27-406c-8474-10cbbe172277

www.cell.com/trends/molecular-medicine/abstract/S1471-4914(16)00013-7?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1471491416000137%3Fshowall%3Dtrue

calcium might mitigate effects of heme iron
www.rug.nl/research/portal/files/3134905/h4.pdf

looks difficult to get rid of SRB with diet, also about 50% of humans are carriers
are we in that 50%
www.pnas.org/content/110/33/13582.full

I guess you need to read this one, seems you cant kill the SRB's easily with antibiotics,
but combine Cipro and bi****h then you can knock them down and kill some
this perhaps why as they mention in the paper antibiotics not great for UC, they were not
tried in conjunction with bi****h
onlinelibrary.wiley.com/doi/10.1016/S0378-1097(03)00748-1/pdf

Post Edited (Old Mike) : 5/1/2016 6:57:08 PM (GMT-6)

Posted 5/1/2016 2:39 PM (GMT 0)
Quote from Old Mike's link above: "To date, these studies have provided sufficient evidence that antibiotics have been useful in the treatment of this disease.

My UC has always been positively affected while on antibiotics. Many years ago I noticed it and just recently had a skin infection bad enough to go to ER where IV vancomycin given and oral Bactrim DS and Keflex. No gut upset, in fact the opposite. I also took some VSL#2 because of worrying about killing all the good bacteria.

On the other hand I think my UC might have been created by overdosing on antibiotics 15 years ago when having lots of dental work done and given repeated anti-bx due to supposed heart murmur. This practice has been discontinued since that time (for all people not just me). Negatives outweighed positives.

Cipro however is the devil to my gut, 1 pill put me on the bathroom floor all night throwing up and D.
That was also years ago (pre-UC) and who knows maybe that was the abx that gutted me.
Posted 5/1/2016 8:50 PM (GMT 0)
My GI thinks my UC is because of using ibuprofen. I was in India for the first 21 years of my life and we use antibiotics like crazy, for everything including for common cold and most of the times with no prescription (lol).

If antibiotics are the reason for UC, 80% of the Indian population should have UC and the rest 20% doesn't have access to the antibiotics because of economical reasons.
Posted 5/2/2016 2:32 AM (GMT 0)
Good point Jared. Old Mike like to talk about umm Korea or Vietnam or something as well. You would think if it was the cause for many the same would occur there.

Also think of the massive agriculture use. Some animals should present with something similar.
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Posted 5/2/2016 9:21 AM (GMT 0)
Mark: Not sure what your asking,we know that in some countries antibiotics are not controlled
and that UC is not rampant,but perhaps rising in incidence.
As for antibiotics being a cause, perhaps in some unlucky people,dont know.
What one of the studies is showing is that SRB's are not killed by at least Cipro or flagyl, unless
pepto is also used, but perhaps there are other antibiotics that will kill it, don't know.

here is a possible UC mechanism.
see figure 5 for a possible UC mechanism
heme make these grow which are mucolytic
Notably, the abundance of the mucin-degrading Akkermansia muciniphila was eightfold increased by heme,
SRB's produce hydrogen sulfide, which degrades the disulfide mucus bonds, mucus is busted
heme is also cytotoxic to colon cells. Bacteria get to the mucosa, inflammation starts
real mess - see above post for live links
www.pnas.org/content/112/32/10038.full?sid=572f8954-ea27-406c-8474-10cbbe172277

www.cell.com/trends/molecular-medicine/abstract/S1471-4914(16)00013-7?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1471491416000137%3Fshowall%3Dtrue
OM[

Post Edited (Old Mike) : 5/2/2016 5:02:56 AM (GMT-6)

Posted 5/5/2016 4:03 AM (GMT 0)
I tried the triple ABX therapy years ago and it worked well for me at the time. Although I have pancolitis, I was having a bout of proctitis that I couldn't get rid of. The Antibiotics cleared up the proctitis and allowed me to get back into remission.
My GI doctor at the time thought that maybe I had Crohn's instead of UC, but a recent colonoscopy confirmed UC.
Antibiotics are obviously risky for people with UC, so I wouldn't really recommend it to anyone, but I was desperate to get rid of the hellish proctitis I was dealing with and was willing to risk it. I was literally crapping my pants at times with the worst urgency you could imagine.
Ironically my UC began when I took Biaxin for bronchitis that wasn't clearing up.
Posted 5/5/2016 8:42 AM (GMT 0)
Like imagardener, the one time I was on antibiotics since my UC diagnosis was the one time my bowel function was entirely 100% normal (4 on the Bristol stool scale). I'm in clinical remission but still normally am a 5 or 6 on the scale (before going on SCD was a 7). I respond well to WOO and probiotics as well. When I told my GI, he said that my experience wasn't unusual for a number of his patients, but that the benefits of antibiotics never last--discontinue them and the UC symptoms return.

As for antibiotic use in India, they seem to have similar UC rates to what is found in Europe and North America. It's also a walking time bomb of antibiotic resistant intestinal infections:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773859/

http://www.nytimes.com/2014/12/04/world/asia/superbugs-kill-indias-babies-and-pose-an-overseas-threat.html
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