Crohn's Disease (cont.)
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 is effective in
treating 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).
- 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 antiinflammatory 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. 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 are considered.
- A new class of topical corticosteroids (budesonide) may have fewer side
effects than systemic corticosteroids.
Next: Immuno-modulator medications »
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