Enhancing ulcerative colitis treatment with traditional Chinese medicine

Inflammatory bowel disease,particularly ulcerative colitis(UC),poses significant treatment challenges due to its chronic nature and potential for severe complications.This editorial reviews a recent network meta-analysis that evaluated the efficacy of and highlighted the superior outcomes achieved by combining each of five traditional Chinese medicine(TCM)formulations with mesalazine for the adjuvant treatment of UC.Clinical outcomes included enhanced mucosal healing,improved quality of life,and reduced recurrence rates.Additionally,the combination therapy resulted in a lower incidence of adverse reactions compared with mesalazine monotherapy.Despite these promising results,limitations such as variability in study quality and TCM dosage highlight the need for further highquality,large-sample,multicenter randomized controlled trials.This editorial underscores the potential of TCM in enhancing UC management and calls for more rigorous research to substantiate these findings and refine clinical guidelines.

Systemic review and network meta-analysis:Prophylactic antibiotic therapy for spontaneous bacterial peritonitis

BACKGROUND Spontaneous bacterial peritonitis(SBP)is an important prognostic factor for outcomes in patients with cirrhosis.Antibiotic prophylaxis is recommended in patients at high risk for developing SBP,but the choice of antibiotics remains unclear.AIM To evaluate the efficacy of various antibiotics for prophylaxis of SBP based on randomized control trials(RCTs).METHODS Electronic databases were searched through November 2018 for RCTs evaluating the efficacy of therapies for primary or secondary prophylaxis of SBP.The primary outcome was the development of SBP.Sensitivity analyses limited to studies of primary or secondary prophylaxis and studies reported after 2010 were performed.The secondary outcome was the risk of all-cause mortality or transplant.The outcomes were assessed by rank of therapies based on network meta-analyses.Individual meta-analyses were also performed.RESULTS Thirteen RCTs(1742 patients)including norfloxacin,ciprofloxacin,rifaximin,trimethoprim-sulfamethoxazole(TMP-SMX),or placebo/no comparator were identified.Individual meta-analyses showed superiority of rifaximin over norfloxacin as well as norfloxacin and TMP-SMX over placebo.Network metaanalysis demonstrated the rank of efficacy in reducing the risk of SBP as:Rifaximin,ciprofloxacin,TMP-SMX,norfloxacin,and placebo/no comparator.Rifaximin ranked highest in sensitivity analyses limited to studies of primary or secondary prophylaxis and studies reported after 2010.Similarly,rifaximin ranked highest in reducing the risk of death/transplant.CONCLUSION The present comprehensive network meta-analysis provides RCT based evidence for superior efficacy of rifaximin compared to other antibiotics for the prophylaxis of SBP and reducing risk of death/transplant.Further RCTs are warranted to confirm our findings.

Antibiotics for eradicating meningococcal carriages:Network meta-analysis and investigation of evidence inconsistency

AIMTo compare different antibiotics for eradicating the carriage of Neisseria meningitidis （N. meningitidis ）, and to investigate heterogeneity and evidence inconsistency.METHODSFrom a search of PubMed and published systematic reviews, we identifed 23 trials evaluating 15 antibiotics that could be connected in a trial network. The outcome of interest is the eradication of N. meningitidis . We used WinBUGS to conduct random-effects, mixed treatment comparisons. Heterogeneity and evidence inconsistency was investigated by meta-regression modelling and examining characteristics of trial participants and inter-ventions evaluated.RESULTS Rifampin, ciprofloxacin, minocycline, ceftriaxone, and azythromycin were statistically significantly （P 〈 0.05） more effective than placebo. The probability of being the best was 67.0% for a combination of rifampin and minocycline, 25.0% for ceftriaxone, 1.7% for azythromycin, and below 1% for the remaining regimens. Signifcant inconsistency between the direct and indirect estimates was observed for the comparison of rifampin and ciprofoxacin （ P 〈 0.01）, which may be caused by different types of carriers and different doses of ciprofoxacin.CONCLUSIONA range of prophylactic antibiotic regimens are effective for eradicating meningococcal carriages, and treatment choice will depend on the individual priorities of the patients and physicians. In clinical situations where complete eradication is considered to be of the utmost importance, a combination of rifampin and minocycline seems to offer the highest likelihood of success. Ceftriaxone as a single intramuscular injection is also likely to be more effective as compared with the other two antibiotics （ciprofoxacin or rifampin） recommended by the current guidelines.