Crohn's disease, ulcerative colitis: no clear role for vancomycin.

Clinical bottom line (level 1b-)

  1. There were no clear differences between vancomycin and placebo in preventing surgery or subsequent relapses in patients with active Crohn's disease or ulcerative colitis.
Dickinson et al: Gut 1985; 26: 1380-1384
Expires May 2003

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: university hospital, UK

40 patients (aged mean 37 years, 83% male) with moderate-to-severe active inflammatory bowel disease (33 Crohn's disease, 7 ulcerative colitis - diagnosed by sigmoidoscopy or barium enema)
Control Group: (n = 18, 18 analysed): placebo
Experimental Group: (n = 22, 22 analysed): vancomycin po 500 mg every six hours for seven days
All patients received bed-rest, prednisolone 40 mg po od, and infusions of blood, electrolytes and albumin as necessary.
100% followed for 12 months
Outcome notes:
  • surgery : if severe continuous or worsening symptoms while on medical therapy and/or occurrence of life-threatening complications

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
surgery 12 months 7
(38.9%)		 4
(18.2%)		 53%
(-35% to 84%)		 20.7%
(-6.99% to 48.4%)		 5
(NNT = 2 to infinity;
NNH = 14 to infinity)
no remission 12 months 11
(61.1%)		 14
(63.6%)		 -4%
(-69% to 36%)		 -2.53%
(-32.7% to 27.7%)		 -40
(NNT = 4 to infinity;
NNH = 3 to infinity)

Comments

  1. The study is too small to show any difference between vancomycin and placebo.

Citation

  1. Dickinson RJ, O'Connor HJ, Pinder I, et al: double blind controlled trial of oral vancomycin as adjunctive treatment in acute exacerbations of idiopathic colitis. Gut 1985; 26: 1380-1384
Search Terms: Crohn* in Cochrane
Contributor: Chris Ball and Clare Wotton, October 2000
Reviewer:

Clinical Question.
Patient Crohn's disease or ulcerative colitis
Intervention or Exposure vancomycin
Comparison placebo
Outcome surgery, remission