Chronic antibiotic therapy as a method of inducing remission in inflammatory bowel disease

Inflammatory bowel disease (IBD) is the general term for the chronic, relapsing, and debilitating inflammatory disorders of the gastrointestinal tract, composed primarily of Crohn’s disease (CD) and Ulcerative colitis (UC). While many similarities exist, CD has a stronger predilection for the terminal ileum while UC is generally confined to the rectum and colon. Further differences exist as CD causes transmural inflammation characterized by skip lesions able to fistulize, while UC only involves the mucosa and is continuous in nature, leaving behind neutrophilic crypt abscesses. Despite the nuanced differences, DeGruttola et al. summarized literature proving that an imbalance of our body’s flora is actually what precipitates disease (1). Given the stark difference in composition, a true imbalance is undeniable. In IBD patients, floral imbalance is then accentuated by a leaky, less resistant, epithelial barrier. Hence, inflammatory markers—with the aid of variant toll-like receptors and nucleotide-binding-oligomerisation-domains—rush fervently to the gut, causing a faster and stronger innate immune response to the host’s abnormal intestinal bacteria (2). Following this logic, antibiotic therapy should be an ideal way to, at least, initially manage IBD patients. Understandingly, at first glance, the risks associated with long-term antibiotic therapy are cumbersome. Before we delve into consideration of this argument, one must realize that alternative therapy is no safe haven either. Additionally, antibiotic therapy may not be as bad as once thought to be due to newly published research in the field