From the Guidelines
Neomycin has not been recommended or studied as a primary treatment for primary sclerosing cholangitis (PSC) in recent guidelines, and its use is not supported by strong evidence. The most recent and highest quality study on the treatment of PSC, published in the Journal of Hepatology in 2022 1, does not mention neomycin as a potential treatment option. Instead, the study suggests that vancomycin may have a positive effect on PSC, either via direct effects on gut microbiota or via indirect host-mediated mechanisms. The study also notes that long-term use of antibiotics is not recommended for treatment of PSC in the absence of recurrent bacterial cholangitis.
Some key points to consider when evaluating the use of antibiotics in PSC include:
- The potential benefits of antibiotics in reducing bacterial translocation and portal endotoxemia, which may contribute to disease progression
- The limited evidence supporting the use of neomycin in PSC, and the potential side effects associated with its use, such as ototoxicity, nephrotoxicity, and gastrointestinal disturbances
- The availability of other treatment options, such as vancomycin, which may have more clinical evidence supporting their use in PSC
- The importance of individualized treatment approaches, taking into account the specific needs and circumstances of each patient
In terms of treatment options, the guidelines recommend that patients with PSC should be managed in a multidisciplinary setting, with consideration given to the use of ursodeoxycholic acid, vancomycin, and other therapies as needed 1. However, neomycin is not mentioned as a recommended treatment option in these guidelines. Overall, the evidence suggests that neomycin is not a first-line therapy for PSC, and its use should be approached with caution and careful consideration of the potential benefits and risks.
From the Research
Neomycin Use in PSC
- There is no direct evidence in the provided studies to suggest that neomycin has been used for the treatment of Primary Sclerosing Cholangitis (PSC) 2, 3, 4, 5, 6.
- The studies discuss various aspects of PSC, including its pathogenesis, diagnosis, and management, but do not mention neomycin as a treatment option.
- Some studies mention the use of antibiotics, such as in the case of bacterial cholangitis, a complication of PSC 2, 6, but neomycin is not specifically mentioned.
- Other studies discuss potential therapeutic strategies for PSC, including the use of ursodeoxycholic acid, nuclear receptor agonists, and antifibrotic agents 5, but neomycin is not included in these discussions.