Vancomycin could offer new therapeutic option for patients with a type of inflammatory bowel disease

An antibiotic used to treat infective diarrhea could be an effective drug for a type of inflammatory bowel disease, a new study has found.

Results published in the Journal of Crohn's and Colitis revealed that an antibiotic called vancomycin may also be effective in treating people who have a specific type of inflammatory bowel disease (IBD), which develops in the context of an incurable autoimmune liver disease called primary sclerosing cholangitis (PSC). Notably, four in five patients who participated in the study achieved remission after taking the drug as part of a clinical trial.

This study conducted by researchers from the University of Birmingham is significant, as several participants with this disease had not responded to other IBD treatments. Moreover, IBD and PSC are closely correlated, with most individuals who have PSC developing IBD, and up to 14% of patients with IBD also developing PSC. This increases the chances of needing colon surgery and getting colon or liver cancer, needing a liver transplant, and the overall risks of death.

Our findings suggest that vancomycin could offer a new therapeutic option for patients with this challenging combination of IBD and autoimmune liver disease. While these results are preliminary, they provide a strong foundation for further research."

Dr. Mohammed Nabil Quraishi, University of Birmingham, corresponding author of the study

80% achieved clinical remission

As part of the trial, participants were treated with the oral antibiotic for four weeks and followed up for a further four weeks during which the medication was discontinued. After four weeks of treatment, 80% of patients achieved clinical remission with a significant decrease in inflammatory markers, and 100% showed mucosal healing. When treatment was stopped, symptoms returned. Vancomycin was also shown to induce changes in certain bile acids, which are now being further investigated to develop and refine treatments for IBD associated PSC.

Dr Palak Trivedi, Associate Professor and Honorary Consultant Hepatologist at the University of Birmingham's Department of Immunology and Immunotherapy, researcher at the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Consultant Hepatologist and Clinician Scientist at University Hospitals Birmingham NHS Foundation Trust, and senior author of the paper, said:

"We are now preparing applications for a randomised controlled trial to determine the therapeutic effects of vancomycin. This next phase of research is crucial to understanding the full potential of vancomycin in PSC-IBD treatment."

The trial was supported by an ECCO Grant – part of European Crohn's and Colitis Organisation Fellowships & Grants Programme, sponsored by the NIHR Birmingham Clinical Research Facility at University Hospitals Birmingham NHS Foundation Trust, and delivered through the NIHR Birmingham Biomedical Research Centre based at the University of Birmingham.