Use of antibiotics in the treatment of active Crohn's disease: experience with metronidazole and ciprofloxacin.

Abstract

BACKGROUND AND AIMS: The use of antibiotics in the treatment of active Crohn's disease has recently increased on the assumption that enteral flora may play a role in the origin of symptoms and/or complications of Crohn's disease. The aim of this study was to evaluate retrospectively the efficacy of metronidazole and/or ciprofloxacin in the treatment of acute phases of Crohn's disease. METHODS: The clinical records of 233 inpatients seen at our clinic for active Crohn's disease and treated with metronidazole and/or ciprofloxacin (1 g daily each) during the period 1984-1996 were reviewed; the patients were divided into three groups according to antibiotic therapy. The primary criterion of success was the achievement of a complete or partial remission evaluated on the basis of the Simple Index; a secondary criterion of success was the efficacy of therapy on individual symptoms and signs. RESULTS: Similar rates of success were obtained with the three schemes of treatment: 70.6% with antibiotic combination, 72.8% with metronidazole, 69.0% with ciprofloxacin. The most frequent symptoms and signs such as diarrhoea, abdominal pain, fever, abdominal mass and abscesses improved in about 60% of patients in the three groups. Remission time after antibiotic treatment was about one year. Side effects requiring discontinuation of therapy occurred in about 20% of patients. CONCLUSIONS: Metronidazole and ciprofloxacin seem to be useful in treating active phases of Crohn's disease. These results strongly support the important role of faecal flora in causing Crohn's disease symptoms.