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Antibiotics and probiotics in inflammatory bowel disease: when to use them?
  1. Bincy Abraham,
  2. Eamonn M M Quigley
  1. Gastroenterology and Hepatology, Houston Methodist, Houston, Texas, USA
  1. Correspondence to Dr Bincy Abraham, Gastroenterology & Hepatology, Houston Methodist, Houston, TX 77030, USA; bpabraham{at}


Antibiotics and probiotics are often used as adjunctive therapy in inflammatory bowel disease. However, data are limited and randomised controlled trials are too inconsistent to provide generalised recommendations for their use in all patients with ulcerative colitis or Crohn’s disease. Antibiotics are best used in the management of infectious complications and fistulas in Crohn’s disease and, perhaps, in reducing the intensity of inflammation in luminal disease. Ciprofloxacin, metronidazole and rifaximin have been most widely used and studied. On the other hand, there appears to be a limited role for antibiotics in ulcerative colitis (UC). Probiotics are most effective in pouchitis, and may have a role in the initial therapy and maintenance of remission in mild UC; the probiotic cocktail VSL#3 has been the most widely studied. There is scant evidence of efficacy for probiotics in Crohn’s disease.

  • antibiotics
  • key points
  • probiotics
  • inflammatory bowel disease
  • ulcerative colitis
  • crohn’s disease

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  • Contributors BA has contributed to the manuscript by reviewing studies and creating the content of this manuscript. EMMQ has also equally contributed to the manuscript by reviewing studies and creating the content of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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