Metronidazole or Rifaximin for Treatment of Clostridium difficile in Pediatric Patients with Inflammatory Bowel Disease (original) (raw)

The Role of Combination Therapy in Pediatric Inflammatory Bowel Disease (IBD): A Clinical Report from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Journal of pediatric gastroenterology and nutrition, 2017

The treatment goal for children suffering from inflammatory bowel disease (IBD) has been evolving with biologic therapies like anti-TNF agents assuming a more central role in treatment of more aggressive and extensive phenotype. Earlier introduction of anti-TNF agents have shown to be more effective and may even alter the natural history of IBD. However, development of anti-drug antibodies (ADA) limits long term usage and leads to dose adjustment in almost half of patients treated with these medications. One of the strategies to minimize the development of ADA has been concomitant use of immunomodulator (IM) medications, resulting in fewer infusion reactions and sustained trough levels, potentially lowering the need for dose adjustments. However, balanced with these benefits of optimized dosing and likely more sustained response, is the concern about increased risk of complications, such as infections and malignancies. The current manuscript reviews the available pediatric literatur...