A Comparative Study of Metronidazole and Sulfasalazine for Active Crohn's Disease: The Cooperative Crohn's Disease Study in Sweden

Ursing, Bo; Alm, Thor; Bárány, F; Bergelin, Ingemar; Ganrot-Norlin, Karin; Hoevels, J.; Huitfeldt, Bernhard; Järnerot, Gunnar; Krause, U; Krook, Aud; Lindström, Björn; Nordle, Örjan; Rosén, Anders

doi:10.1016/s0016-5085(82)80189-3

Cited by 319 publications

(62 citation statements)

References 27 publications

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“…Furthermore, the addition of antibiotics to these agents does not appear to add significant clinical benefit. Importantly, the location of disease appears to have an impact on the efficacy of antibacterial therapy, with greater efficacy in colonic compared with ileal disease, 56,58,64,65 although none of these trials was specifically designed to assess patient subgroups with respect to location of disease. 66 Differences in enteric flora between the ileum and colon may explain this difference in antimicrobial effectiveness.…”

Section: Use Of Antibiotics In Treatment Of Ibdmentioning

confidence: 99%

Use of antibiotics in the treatment of inflammatory bowel disease

Perencevich

Burakoff

2006

Inflammatory Bowel Diseases

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An increasing amount of evidence suggests that enteric flora may have a role in the pathogenesis of inflammatory bowel disease (IBD). Patients with IBD appear to have an altered composition of luminal bacteria that may provide the stimulus for the chronic inflammation characterizing IBD. The suspected role of bacteria in the pathogenesis of IBD provides the rationale for using agents, such as antibiotics, that alter the intestinal flora. However, there remains much uncertainty about the optimal use of antibiotics in the treatment of Crohn's disease, ulcerative colitis, and pouchitis. This article reviews the literature and presents a clinical model for the use of antibiotics in IBD.

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Section: Use Of Antibiotics In Treatment Of Ibdmentioning

confidence: 99%

Use of antibiotics in the treatment of inflammatory bowel disease

Perencevich

Burakoff

2006

Inflammatory Bowel Diseases

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“…Agents such as metronidazole and cipro¯oxacin are further alternative treatments in mild-to-moderate Crohn's disease, but their ef®cacy does not seem superior to that of 5-ASA. 58,59 Studies on antibiotics as maintenance therapy in Crohn's disease are scarce, particularly in steroid-treated patients. One double-blind placebocontrolled trial showed that metronidazole therapy signi®cantly reduced clinical recurrence rates after ileal resection at 1 year, compared with placebo (P 0.046).…”

Section: Antibioticsmentioning

confidence: 99%

The limitations of corticosteroid therapy in Crohn’s disease

Rutgeerts

2001

Aliment Pharmacol Ther

126

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Corticosteroids are highly effective in inducing clinical remission in patients with active Crohn’s disease. However, the role of corticosteroids in the treatment of this disease is primarily ameliorative because they are ineffective in maintaining remission or healing mucosal lesions. Nearly half of the patients who initially respond to corticosteroid therapy develop a dependency on corticosteroids or have a relapse within 1 year. In addition, use of these agents is often limited by a relatively high risk of serious adverse effects that can involve nearly every major body system. These effects include: bone loss, which can develop with even short‐term and low‐dose corticosteroid therapy; metabolic complications such as glucose intolerance and diabetes mellitus; increased intraocular pressure and glaucoma; and potentially lethal infections. To minimize the risk of toxicity, corticosteroids are increasingly recommended for short‐term use only at the lowest effective dose to induce remission in patients with moderately to severely active Crohn’s disease. Corticosteroid formulations with low systemic bioavailability, such as controlled‐release budesonide, may be associated with a lower rate of dermatologic adverse effects but appear to be somewhat less effective than conventional corticosteroids in inducing remission in patients with active Crohn’s disease. Immunosuppressive agents such as azathioprine, 6‐mercaptopurine, and methotrexate have demon‐ strated corticosteroid‐sparing effects, facilitating the withdrawal of corticosteroids when initiated as maintenance therapy. Infliximab can be used as an alternative to corticosteroids.

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“…21 Meanwhile, successful management of pouchitis after ileal pouch-anal anastomosis for ulcerative colitis with metronidazole was also reported in clinical series. [23][24][25] Metronidazole had been proved to have similar effects compared with sulfasalazine in Crohn's disease, 26 and its use also has benefit in the treatment of perianal suppurations in the latter. 27 When the mucosal defense system fails to resist the body's own mucosal bacteria and luminal antigens, inflammatory response begins and macrophage activation and delayed-type hypersensitivity reactions occur.…”

Section: Discussionmentioning

confidence: 99%

Effect of mesalazine, metronidazole and gentamicin on bacterial translocation in experimental colitis

Yigitler¹,

Güleç²,

Aydoğan³

et al. 2004

J of Gastro and Hepatol

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Gram-negative enteric bacteria, predominantly E. coli, was the most common bacteria isolated in bacterial translocation occurring in acetic acid-induced colitis. This trial showed that mesalazine alone did not incorporate the reduction of infectious events, despite its beneficial effect on inflammatory changes in experimental colitis. Metronidazole and gentamicin combination given intraperitoneally was more effective than topical mesalazine in decreasing bacterial translocation.

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A Comparative Study of Metronidazole and Sulfasalazine for Active Crohn's Disease: The Cooperative Crohn's Disease Study in Sweden

Cited by 319 publications

References 27 publications

Use of antibiotics in the treatment of inflammatory bowel disease

Use of antibiotics in the treatment of inflammatory bowel disease

The limitations of corticosteroid therapy in Crohn’s disease

Effect of mesalazine, metronidazole and gentamicin on bacterial translocation in experimental colitis

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