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International Journal of Pharmacology
  Year: 2010 | Volume: 6 | Issue: 6 | Page No.: 826-835
DOI: 10.3923/ijp.2010.826.835
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A Review and Meta-analysis of the Efficacy of Antibiotics and Probiotics in Management of Pouchitis

S. Nikfar, M. Darvish-Damavandi and M. Abdollahi

Pouchitis is the most frequent long-term complication of Ileal Pouch-Anal Anastomosies (IPAA) surgery for Ulcerative Colitis (UC) which is a nonspecific inflammation of the ileal reservoir. Its clinical frequency varies depending on the definition and the follow up but is approximately 50% after a decade. Antibiotics and probiotics are currently the most widely accepted treatment in pouchitis patients. Objective of this study was to meta-analyze efficacy of probiotics and antibiotics in the management of pouchitis. All databases specially Pubmed, Web of Science, Scopus, Cochrane and Google Scholar were searched between 1965 and December 2009 and relevant controlled clinical trials were extracted, reviewed and validated according to the study protocol. The outcome of interest was defined by a Pouchitis Disease Activity Index (PDAI)<7. Thirteen clinical trials were included in the meta-analysis. Pooling of the results from eight trials yielded a Relative Risk (RR) of 5.33 with a 95% CI of 2.12-13.35 and a significant RR (p = 0.0004) in all kind of probiotics treatment group in comparison with the placebo group. Summary RR for clinical improvement in six trials was 14.17 with a 95% CI of 1.19-168.93 (p = 0.036) in efficacy of VSL#3 (all doses) comparing to placebo and slightly more effective for VSL#3 (6 g day-1) comparing to placebo with RR of 20.35 with a 95% CI of 6.16-67.22 (p<0.0001). Efficacy of antibiotics comparing to placebo showed a summary RR of 2.68 with a 95% CI of 0.4-17.99 and p = 0.3107 for clinical improvement in three trials. The summary RR for efficacy of ciprofloxacin comparing to metronidazole was 0.68 with a 95% CI of 0.44-1.06 (p = 0.8913). In conclusion, alongside the benefit of probiotics and antibiotics in the management of pouchitis, effects of probiotics and antibiotics on pouchitis vary according to different mixtures of microorganisms strains in probiotics and different spectrums of antibiotics.
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  •    Comparison of the Efficacy and Tolerability of Herbal Medicines with 5-aminosalisylates in Inflammatory Bowel Disease: A Meta-analysis of Placebo Controlled Clinical Trials Involving 812 Patients
  •    A Comprehensive Review of Antibiotics in Clinical Trials for Inflammatory Bowel Disease
  •    Better Efficacy of Lactobacillus casei in Combination with Bifidobacterium bifidum or Saccharomyces boulardii in Recovery of Inflammatory Markers of Colitis in Rat
  •    Effect of Probiotics on the Haematological Parameters of Indian Magur (Clarius batrachus L.)
How to cite this article:

S. Nikfar, M. Darvish-Damavandi and M. Abdollahi, 2010. A Review and Meta-analysis of the Efficacy of Antibiotics and Probiotics in Management of Pouchitis. International Journal of Pharmacology, 6: 826-835.

DOI: 10.3923/ijp.2010.826.835






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