Controlled trial of intravenous metronidazole as an adjunct to corticosteroids in severe ulcerative colitis.

Abstract

SUMMARY A prospective double blind controlled trial was undertaken to examine the role of metronidazole as an adjunct to corticosteroids in the management of severe ulcerative colitis. Thirty nine patients with severe ulcerative colitis were randomised on admission to hospital to receive either intravenous metronidazole 500 mg eight hourly (19 patients) or an identical intravenous placebo (20 patients). The two groups were similar with respect to age, sex, and the extent of colitis. In addition all patients received a standard intravenous regimen consisting of methyl prednisolone 16 mg six hourly and parenteral nutrition together with a twice daily hydrocortisone 100 mg enema. Treatment was continued for five days when the patients were formally assessed. Fourteen of 19 patients (74%) receiving metronidazole and 14/20 (70%) receiving placebo were substantially improved, or in remission at the end of five days. Five patients treated with metronidazole and six with placebo had no improvement and all proceeded to urgent colectomy with no operative mortality. There were three late deaths, one in the metronidazole and two in the placebo group. These results do not support the routine use of intravenous metronidazole in the treatment of severe ulcerative colitis.

Infliximab three-dose induction regimen in severe corticosteroid-refractory ulcerative colitis: Early and late outcome and predictors of colectomy

“…The diagnosis of UC was established according to standard criteria. 16 All patients had required hospitalization for an acute severe attack as defined by Truelove and Witts criteria 17 and modified by Chapman et al 18 : six or more bloody stools per day with at least one of the remaining criteria: fever (mean evening N 37.5°C or N 37.8°C for 2 days out of four), tachycardia (mean pulse rate N 90 per minute), anaemia (decrease in haemoglobin levels greater than 75%), and erythrocyte sedimentation rate (ESR) N 30 mm/h. All patients were candidates for colectomy because of resistance to i.v.…”

Comparative study of the intestinal mucus barrier in normal and inflamed colon

“…The diagnosis of ulcerative colitis was made according to established criteria. 11 Patients with subtotal colitis or pancolitis of low-moderate activity treated with 3 g mesalazine orally were included. Patients occasionally treated with prednisolone or azathioprine, were also included.…”

Antibiotic Treatment Alters the Colonic Mucus Layer and Predisposes the Host to Exacerbated Citrobacter rodentium -Induced Colitis

“…Metronidazole is used extensively in the treatment of IBD, with variable efficacy (20,45). In ulcerative colitis, metronidazole has been found to be ineffective in double-blind, placebo-controlled trials, compared to standard steroid treatment (13,36). In Crohn's disease, the use of metronidazole is still highly controversial, as it shows variable efficacy (2,8,51,52).…”