Is Oral Vancomycin Effective for Paediatric IBD?

TOPLINE:

Oral vancomycin was effective in achieving clinical and biochemical remission in paediatric patients with non-primary sclerosing cholangitis (PSC) inflammatory bowel disease (IBD), enabling almost half of the participants to reduce or stop other treatments. The treatment showed the greatest benefit among patients with mildly active ulcerative colitis (UC) and IBD unclassified (IBDU).

METHODOLOGY:

• Researchers conducted a retrospective study at a hospital in Edinburgh and included 31 paediatric patients (median age at diagnosis, 13.1 years; 52% boys) with IBD who started on oral vancomycin at any point during their illness for active luminal colonic disease and/or drug dependency between January 2017 and August 2024.
• Patients weighing 30 kg or more received oral vancomycin at a dose of 250 mg, whereas those weighing less than 30 kg received 125 mg, administered three or four times daily, with dose tapering after at least 1 month for those who responded to the treatment.
• Disease activity was assessed using the Paediatric Ulcerative Colitis Activity Index (PUCAI) for patients with UC (n = 23) and IBDU (n = 4) and the weighted Paediatric Crohn’s Disease Activity Index (wPCDAI) for those with Crohn’s disease (CD; n = 4) at baseline and 1, 3, 6, and 12 months post-treatment initiation and at the end of follow-up.
• The ability of oral vancomycin to induce and maintain clinical and biochemical remission was assessed in paediatric patients with non-PSC IBD, as well as in non-responders and responders.
• Clinical remission was defined as a PUCAI score < 10 or a wPCDAI score < 12.5, and biochemical remission was defined as faecal calprotectin levels < 250 μg/g. Patients who achieved or maintained both clinical and biochemical remission after starting oral vancomycin were referred to as responders.

TAKEAWAY:

• Overall, 17 of 31 patients (55%) — 13 with UC, three with IBDU, and one with CD — were responders, with 15 (88%) later reducing or stopping concomitant treatments. By contrast, 14 of 31 patients (45%) discontinued oral vancomycin — 11 for non-response and three for intolerance — who were referred to as non-responders, with 11 (79%) stopping the treatment within 1 month.
• Responders had a lower baseline PUCAI score (median, 15 vs 35; P = .01) and lower platelet counts (321 vs 370 × 10³/mm³; P = .04) than non-responders.
• In responders, faecal calprotectin levels reduced from 686 μg/g at baseline to 60 μg/g at 1 month (P = .001); the levels remained stable in non-responders.
• No severe adverse events were reported; mild adverse events were more frequent in non-responders than in responders (64% vs 23%; P = .03).

IN PRACTICE:

“Based on our pilot data, OV [oral vancomycin] is a useful option for a subgroup of mildly active UC/IBDU patients,” the authors of the study concluded. “While systematic OV use before biologic or steroid escalation cannot yet be universally recommended, it may be considered in previously unexposed patients with mildly active UC/IBDU uncontrolled by conventional treatments or resistant to biologics,” they added.

SOURCE:

This study was led by Silvana Ancona and Laura Gianolio, Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children and Young People, Edinburgh, Scotland. It was published online on August 05, 2025, in the Journal of Pediatric Gastroenterology and Nutrition.

LIMITATIONS:

The study’s retrospective design may have introduced selection and recall biases. The sample size was small, and a control group was lacking. The variability in drug regimens complicated the dose-response analysis.

DISCLOSURES:

This study did not receive any specific funding. One author reported receiving speaker fees and travel support and serving as a consultant for various pharmaceutical, healthcare, and biopharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.