Role of the Microbiota and Antibiotics in Primary Sclerosing Cholangitis

Table 1

Previously reported results of antibacterial treatment in primary sclerosing cholangitis.

(a) Clinical trials of antibacterial treatment in primary sclerosing cholangitis

Drug (reference)	Year	𝑛	Antibiotic dose	Months of therapy	Change after therapy
					ALK	AST	ALT
Metronidazole (+UDCA) [34]	2004	39	600–800 mg/day	36	−52.4%	−41.0%	−67.9%
Minocycline [35]	2009	16	200 mg/day	12	−19.7%	−2.8%	NA
Vancomycin or metronidazole [25]	2013	18	Vancomycin 125 or 250 mg qid	3	−42%	−22%	NA
		17	Metronidazole 250 or 500 mg tid	3	−10%	−9%	NA

(b) Case series and reports of antibacterial treatment in primary sclerosing cholangitis

Drug (reference)	Year	𝑛	Antibiotic dose	Months of therapy	Change after therapy
					ALK	AST	ALT
Tetracycline [36]*	1959	5	500 mg/day	1–10	−45%	−60%	−45%
Tetracycline [27]^†	1965	5	500 mg/day	48 (mean)	−21%	NA	NA
Metronidazole [37]	1983	1	800 mg/day	0.25	NA^‡‡	NA^‡‡	NA^‡‡
Sulfasalazine (+UDCA) [38]^††	1998	2^‡	—	30 and; 45	−79%; −35%	−38%; −87%	−70%; −95%
Vancomycin [39]	1998	3^‡	375–1000 mg/day	9 (mean)	NA	NA	−89%
Sulfasalazine (+UDCA) [40]	2002	1	50 mg/kg/day	37	NA	NA	−92%
Sulfasalazine [41]	2006	1	2–4.5 g/day	24	−74%	NA	−84%
Azithromycin (+UDCA) [42]	2007	1	500 mg/day, 3 days/week	5	−72%	−31%	−33%
Vancomycin [43]	2008	14^‡	50 mg/kg/day	54 ± 43	NA	NA	−78%

Key: ALK: alkaline phosphatase, AST: aspartate aminotransferase; ALT: alanine aminotransferase, GGT: γ-glutamyl transpeptidase; tid: three times a day; qid: four times a day; UDCA: ursodeoxycholic acid.
Months of treatment and followup are absolute unless otherwise indicated.
*Includes one patient who also received prednisone but was not separable from the other 4 patients.
^†Does not include two patients who received prednisone.
^††Does not include a third patient who also received prednisolone and mizoribine.
^‡Pediatric patients.
^‡‡Original case report states there was dramatic improvement in patient’s condition, including defervescence, return of appetite, and reduction of serum bilirubin, and after 2 weeks, becoming completely asymptomatic. Six months later, patient returned with clinical worsening, which again responded to metronidazole.