Role of antibiotics and probiotics in the management of inflammatory bowel disease

An infectious cause or contribution to the primary pathogenesis of inflammatory bowel disease (IBD) has not been demonstrated, ahhough many studies have followed that track [1]. However, the deleterious role of some microorganisms from the endogenous flora is also now well estabhshed in the majority of models of colitis or enteritis [1-4]. Antibiotics have a weU-estabHshed role in the management of complications of IBD such as abscess and pouchitis. Whether antibiotics are of use as a primary therapy for either Crohn's disease (CD) or ulcerative colitis (UC) is less clear. An alternative way of influencing intestinal ecology is the use of probiotics or prebiotics. Probiotics are defined as living non-pathogenic microorganisms which, when ingested, exert a positive influence on host health or physiology [5, 6]. Prebiotics have been defined as non-digestible food ingredient that beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon, that have the potential to improve host health [7]. As some animal studies have shown that probiotics or prebiotics may help in preventing or curing experimental colitis, clinical trials have begun in IBD. This chapter focuses on the use of metronidazole and ciprofloxacin in CD and pouchitis. In addition, existing data on the use of other antimicrobial agents and on the potential for probiotics in IBD is reviewed.