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Crohn's Disease (cont.)

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Antibiotics for Crohn's disease

Antibiotics such as metronidazole (Flagyl) and ciprofloxacin (Cipro) have been used for treating Crohn's colitis. Flagyl also has been useful in treating anal fistulae in patients with Crohn's disease. The mechanism of action of these antibiotics in Crohn's disease is not well understood.

Metronidazole (Flagyl)

Metronidazole (Flagyl) is an antibiotic that is used for treating several infections caused by parasites (for example, giardia) and bacteria (for example, infections caused by anaerobic bacteria, and vaginal infections). It might have some activity in the treatment of Crohn's colitis and is particularly useful in treating patients with anal fistulae. Chronic use of metronidazole in doses higher than 1 gram daily can be associated with permanent nerve damage (peripheral neuropathy). The early symptoms of peripheral neuropathy are numbness and tingling in the fingertips, toes, and other parts of the extremities. Metronidazole should be stopped promptly if these symptoms appear. Metronidazole and alcohol together can cause severe nausea, vomiting, cramps, flushing, and headache. Patients taking metronidazole should avoid alcohol. Other side effects of metronidazole include nausea, headaches, loss of appetite, a metallic taste, and, rarely, a rash.

Ciprofloxacin (Cipro)

Ciprofloxacin (Cipro) is another antibiotic used in the treatment of Crohn's disease. It can be used in combination with metronidazole.

Summary of antiinflammatory medications

  • Azulfidine, Asacol, Pentasa, Dipentum, Colazal and Rowasa all contain 5-ASA which is the active topical antiinflammatory ingredient. Azulfidine was the first 5-ASA medication used in treating ulcerative colitis and Crohn's disease, but the newer 5-ASA medications have fewer side effects.
  • Pentasa and Asacol have been found to be effective in treating patients with Crohn's ileitis and ileo-colitis. Rowasa enemas and Canasa suppositories are safe and effective for treating patients with proctitis. For mild to moderate Crohn's ileitis or ileo-colitis, doctors usually start with Pentasa or Asacol. If Pentasa or Asacol is ineffective, doctors may try antibiotics such as Cipro or Flagyl for prolonged periods (often months), though the literature suggests that the efficacy of antibiotics in treating Crohn's disease is poor.
  • In patients with moderate to severe disease and in patients who fail to respond to 5-ASA compounds and/or antibiotics, systemic corticosteroids can be used. Systemic corticosteroids are potent and fast-acting anti-inflammatory agents for treating Crohn's enteritis and colitis as well as ulcerative colitis.
  • Systemic corticosteroids are not effective in maintaining remission in patients with Crohn's disease, and serious side effects can result from prolonged corticosteroid treatment.
  • To minimize side effects, corticosteroids should be gradually tapered as soon as a remission is achieved. In patients who become corticosteroid dependent or are unresponsive to corticosteroid treatment, surgery or immuno-modulator treatment is considered.
  • A newer class of topical corticosteroids (budesonide) seems to have fewer side effects than systemic corticosteroids.
Medically Reviewed by a Doctor on 11/4/2015


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