Controlled trial of metronidazole treatment for prevention of crohn's recurrence after ileal resection

Rutgeerts, Paul; Hiele, Martin; Geboes, Karel; Peeters, Marc; Penninckx, Freddy; Aerts, Raymond; Kerremans, Raymond

doi:10.1016/0016-5085(95)90121-3

Cited by 707 publications

(373 citation statements)

References 22 publications

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“…Overall, the ECCO consensus and a North American Pediatric Workshop support a modest overall bene t of approximately 1 in 10 patients (NNT = 10) for mesalamine at delaying / preventing postoperative recurrence (77,238) . Short-term administration of high-dose metronidazole, 20 mg / kg, and a 1-year course of ornidazole, 1 g / day, also reduce the likelihood of recurrence for up to 1 year (243,244) . However, both agents have been poorly tolerated due to an increased risk of peripheral neuropathy such that additional studies of alternative antibiotics or additional dosing studies are required to identify a safe and e ective regimen.…”

Section: Maintenance Therapymentioning

confidence: 99%

Management of Crohn's Disease in Adults

2009

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Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifi cally valid research, derived from extensive review of published literature. When data that will withstand objective scrutiny are not available, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be fl exible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are infl exible and rarely violated. Given the wide range of choices in any health-care problem, the physician should select the course best suited to the individual patient and the clinical situation presented. These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. Expert opinion is solicited from the outset for the document. The quality of evidence upon which a specifi c recommendation is based is as follows: Grade A: Homogeneous evidence from multiple well-designed randomized (therapeutic) or cohort (descriptive) controlled trials, each involving a number of participants to be of suffi cient statistical power. Grade B: Evidence from at least one large well-designed clinical trial with or without randomization, from cohort or case -control analytic studies, or well-designed meta-analysis. Grade C: Evidence based on clinical experience, descriptive studies, or reports of expert committees. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fi elds. The fi nal recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientifi c developments at a later time.

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Section: Maintenance Therapymentioning

confidence: 99%

Management of Crohn's Disease in Adults

2009

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“…Rutgeerts and coworkers published two double-blind randomized studies of the efficacy of nitroimidazole antibiotics in the prevention of postoperative CD (Rutgeerts et al, 2005;Rutgeerts et al, 1995). In the first study, one week after resection surgery, 30 patients started to receive antibiotic metronidazole at a dose of 20 mg/kg body weight once a day for a period of three months (Rutgeerts et al, 1995).…”

Section: Antibiotics In the Prevention Of Post-operative CDmentioning

confidence: 99%

Manipulation of Intestinal Flora as a Way to Treat Crohn's Disease: The Role of Probiotics, Prebiotics and Antibiotics

Zadravec¹,

Štrukelj²,

Berlec³

2012

Crohn's Disease

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“…In summary, although none of these studies offer robust data to support the use of azathioprine/6-mercaptopurine in the prevention of postoperative recurrence, many clinicians use these drugs for this indication. Antibiotics: In a randomized, placebo-controlled trial a significant decrease was observed in the incidence of severe endoscopic recurrence with metronidazole treatment as compared to placebo after ileal resection [68] . In addition, metronidazole therapy statistically reduced the clinical recurrence rates at 1 year.…”

Section: Postoperative CD (Surgically-induced Remission)mentioning

confidence: 99%

Conventional therapy for Crohn’s disease

Büning

Lochs²

2006

WJG

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Crohn's disease (CD) is a multifactorial disorder of unknown cause. Outstanding progress regarding the pathophysiology of CD has led to the development of innovative therapeutic concepts. Numerous controlled trials have been performed in CD over the last years. However, many drugs have not been approved by regulatory authorities due to lack of efficacy or severe side effects. Therefore, well-known drugs, including 5-ASA, systemic or topical corticosteroids, and immunosuppressants such as azathioprine, are still the mainstay of CD therapy. Importantly, biologicals such as infliximab have shown to be efficacious in problematic settings such as fistulizing or steroid-dependent CD. This review is intended to give practical guidelines to clinicians for the conventional treatment of CD. We concentrated on the results of randomized, placebo-controlled trials and meta-analyses, when available, that provide the highest degree of evidence. We provide evidence-based treatment algorithms whenever possible. However, many clinical situations have not been answered by controlled clinical trials and it is important to fill these gaps through expert opinions. We hope that this review offers a useful tool for clinicians in the challenging treatment of CD.

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Controlled trial of metronidazole treatment for prevention of crohn's recurrence after ileal resection

Cited by 707 publications

References 22 publications

Management of Crohn's Disease in Adults

Management of Crohn's Disease in Adults

Manipulation of Intestinal Flora as a Way to Treat Crohn's Disease: The Role of Probiotics, Prebiotics and Antibiotics

Conventional therapy for Crohn’s disease

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