Metronidazole for Crohn's Disease

Ursing, Bo; Kamme, Carl

doi:10.1016/s0140-6736(75)92438-1

Cited by 196 publications

(42 citation statements)

References 11 publications

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“…Medical therapy has demonstrated limited efficacy with relapse after cessation of treatment. [22][23][24][25][26][27][28][29][30][31][32] Operative treatment has shown good results [33][34][35] but puts the patient at an increased risk for fecal incontinence.…”

Section: Discussionmentioning

confidence: 99%

Does Infliximab Infusion Impact Results of Operative Treatment for Crohn's Perianal Fistulas?

Gaertner¹,

Decanini²,

Mellgren³

et al. 2007

Diseases of the Colon &Amp; Rectum

102

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Section: Discussionmentioning

confidence: 99%

Does Infliximab Infusion Impact Results of Operative Treatment for Crohn's Perianal Fistulas?

Gaertner¹,

Decanini²,

Mellgren³

et al. 2007

Diseases of the Colon &Amp; Rectum

102

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“…In several uncontrolled studies, metronidazole and ciprofloxacin were first evaluated with promising results, although mostly a high proportion of recurrence after treatment discontinuation was observed [6,51,52,53]. Three RCTs are currently available which evaluate metronidazole and ciprofloxacin in CD patients with perianal fistulas [54,55,56].…”

Section: Review Of the Evidencementioning

confidence: 99%

The Role of Anti(myco)bacterial Interventions in the Management of IBD: Is There Evidence at All?

Chambrun¹,

Torres

Darfeuille‐Michaud

et al. 2012

Dig Dis

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Background/Aims: The etiology of IBD is unknown but may relate to an unidentified bacterial pathogen or an immunological reaction to gut microbiota. Antibiotics have therefore been proposed as a therapy for Crohn’s disease (CD) and ulcerative colitis (UC). The aim of this review was to compel the evidence for the use of antibiotics in the treatment of IBD. Methods: We performed a systematic review of the literature regarding the use of antibiotics for inducing or maintaining remission in IBD. Results: Current data are conflicting, but a recent systematic review of randomized controlled trials has shown a statistically significant effect of antibiotics being superior to placebo for active, perianal and quiescent CD and for active UC. These data have been poorly translated in clinical practice and the place of antibiotics is restricted to certain specific situations in the international guidelines. This is first linked to the difficulties in interpreting clinical trials because of their heterogeneity in study design, endpoints, type of antibiotic and concomitant therapies. The exception to this is the use of either ciprofloxacin or metronidazole for treating CD perianal fistulas. Conclusion: The pathology of CD, the likely primary and known secondary pathogens in this disease and the successful responses in animal models all plead for new trials of antibiotics in IBD. This is a call to select patients more carefully, and to continue antibiotics for longer than is customary. Beside antibiotics, new therapeutic approaches that can balance gut dysbiosis should be tested.

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“…Metronidazole, active against some parasites and most anaerobic bacteria, including Bacteroides and Clostridium species, was first reported to be effective in CD in an open study in 1975 [36]. Ciprofloxacin is a quinolone derivative with a selective suppressive effect on the intestinal microflora.…”

Section: Antibiotics As a Treatment Of Inflammatory Bowel Diseasementioning

confidence: 99%

Antibiotics and Inflammatory Bowel Diseases

Scribano

Prantera²

2013

Dig Dis

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Inflammatory bowel diseases are characterized by an altered composition of gut microbiota (dysbiosis) that may contribute to their development. Antibiotics can alter the bacterial flora, and a link between antibiotic use and onset of Crohn's disease (CD), but not ulcerative colitis, has been reported. The hypothesis that Mycobacterium avium subspecies paratuberculosis (MAP) could be an etiologic agent of CD has not been confirmed by a large study on patients treated by an association of antibiotics active against MAP. The observations supporting a role of intestinal microbiota in CD pathogenesis provide the rationale for a therapeutic manipulation of the intestinal flora through the employment of antibiotics. However, current data do not strongly support a therapeutic benefit from antibiotics, and there is still controversy regarding their use as primary therapy for treatment of acute flares of CD, and for postoperative recurrence prevention. Nevertheless, clinical practice and some studies suggest that a subgroup of patients with colonic involvement, early disease, and abnormal laboratory test of inflammation may respond better to antibiotic treatment. Since their long-term use is frequently complicated by a high rate of side effects, the use of antibiotics that work locally appears to be promising.

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Metronidazole for Crohn's Disease

Cited by 196 publications

References 11 publications

Does Infliximab Infusion Impact Results of Operative Treatment for Crohn's Perianal Fistulas?

Does Infliximab Infusion Impact Results of Operative Treatment for Crohn's Perianal Fistulas?

The Role of Anti(myco)bacterial Interventions in the Management of IBD: Is There Evidence at All?

Antibiotics and Inflammatory Bowel Diseases

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