Antibiotic therapy for treatment in relapse of intestinal Crohn's disease

Abstract

We have undertaken a prospective randomized trial of one month's antimicrobial therapy for patients with symptomatic relapse of Crohn's disease. Criteria for entry included two major symptoms: fever, abdominal pain, diarrhea, weight loss, abdominal mass or complications (excluding perianal disease); and two hematologic abnormalities: hemoglobin, ESR, albumin, C reactive protein, iron, or total iron binding capacity. Patients were monitored for the aforementioned clinical and hematologic (hemoglobin, albumin, CRP) parameters over six weeks and for changes in fecal flora. Randomization was to four groups: metronidazole alone (M), cotrimoxazole alone (C), metronidazole and cotrimoxazole (C plus M), or double placebo (P). Seventy-two patients entered the study (18 = M, 16 = C, 21 = C plus M, 17 = P). After two weeks, improvement was reported as follows: M = 67 percent, C = 17 percent, C plus M = 71 percent, P = 35 percent. In the metronidazole group, two patients required surgery and one had troublesome side effects. In the cotrimoxazole group, two had side effects. In the combined group (C plus M), four had troublesome side effects and two of the placebo group (P) required operation. By four weeks, there was no difference in response among the groups: (M = 44 percent, C = 62 percent, C plus M = 57 percent, P = 41 percent). Antimicrobials had no effect on fecal flora or hematologic parameters. These results indicate that antimicrobials have little therapeutic potential for relapse of intestinal Crohn's disease.

Antibiotic Treatment Alters the Colonic Mucus Layer and Predisposes the Host to Exacerbated Citrobacter rodentium -Induced Colitis

“…In ulcerative colitis, metronidazole has been found to be ineffective in double-blind, placebo-controlled trials, compared to standard steroid treatment (13,36). In Crohn's disease, the use of metronidazole is still highly controversial, as it shows variable efficacy (2,8,51,52). Streptomycin treatment did not show the same effects as did metronidazole; thus, our data outline a scenario in which certain antibiotic treatments (e.g., metronidazole) would have an effect on both the microbial composition and the immune status of the intestine.…”

Management of Crohn's Disease in Adults

“…e small sample size of this trial and the relatively small therapeutic e ect of sulfasalazine ( ≤ 15 % ) make interpretation of this trial di cult. Two small placebo-controlled trials with metronidazole 1 g daily and metronidazole 800 mg daily in combination with co-trimoxazole did not demonstrate e cacy in the treatment of active CD (102,103) . ere are no long-term e cacy data regarding metronidazole.…”

Inflammatory Bowel Disease in Korea: Epidemiological, Genomic, Clinical, and Therapeutic Characteristics

“…Although metronidazole and ciprofloxacin are often used for the treatment of CD, controlled trials have failed to show convincing evidence of their efficacy for the induction of remission in active CD. [88][89][90][91] Budesonide undergoes extensive first-pass hepatic metabolism, which reduces the side effects associated with systemic corticosteroids. Well controlled studies have revealed that budesonide is significantly more effective than placebo and 5-ASA, and is about as effective as conventional corticosteroids for inducing remission in active CD.…”