Metronidazole in the treatment of chronic proctitis: a controlled trial.

Davies, Paul S.; Rhodes, JM; Heatley, R. V.; Owen, E

doi:10.1136/gut.18.8.680

Cited by 40 publications

(4 citation statements)

References 6 publications

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“…Since metronidazole was introduced for the therapy of Crohn's disease by Ursing and Kamme [1], several controlled and uncontrolled clinical studies have been published on the efficacy of this com pound [2][3][4][5][6][7][8][9]. The latest study was the cooperative Crohn's disease study, carried out in Sweden [9], in which metronidazole has been definitely classified among the compounds with proven therapeutic value in Crohn's disease.…”

Section: Introductionmentioning

confidence: 99%

Serum Concentrations of Metronidazole and Its Main Metabolite in Patients with Active Crohn’s Disease: Correlation with Disease Activity and Therapeutic Efficacy?

1984

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Serum concentrations of metronidazole and its main metabolite [1-(2-hydroxyethyl)-2-hydroxymethyl-5-nitroimidazole] have been determined by high performance liquid chromatography in sera of 10 patients with histologically confirmed ileocolitis Crohn, 7 presenting with highly active disease and pathologically increased Crohn’s disease activity index (CDAI) and 3 with secreting fistulas but normal CDAI. Metronidazole serum concentrations showed dose-dependent peak characteristics and ranged between 10.62 ± 0.95 and 24.88 ± 3.63 μg/ml for a metronidazole intake of 1,000 mg/day and between 5.04 ± 1.13 and 9.21 ± 1.00 μg/ml for a daily intake of 400 mg, whereas its metabolite leveled at constant serum concentrations up to 24 h after onset of therapy, with 7.50 ± 1.40 μg/ml for a metronidazole intake of 1,000 mg/day and 3.20 ± 0.60 μg/ml for an intake of 400 mg/day. Considering the known minimum inhibitory concentration of metronidazole for anaerobic bacteria involved in Crohn’s disease, this work has shown 400 mg metronidazole to be the minimum daily dosage. Correlation analysis, although limited by the small number of patients investigated so far, indicated a possible positive correlation between metronidazole serum concentrations and disease activity (CDAI, r = 0.480) and therapeutic efficacy (ΔCDAI, r = 0.430) in Crohn’s disease.

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Section: Introductionmentioning

confidence: 99%

Serum Concentrations of Metronidazole and Its Main Metabolite in Patients with Active Crohn’s Disease: Correlation with Disease Activity and Therapeutic Efficacy?

1984

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“…Oral patients with mild-to-moderate active UC. [21,22] However, meglucocorticoids, including prednisone and prednisolone (1-2 mg/ kg/day), are highly effective in these patients, many of whom may tronidazole displays modest efficacy relative to sulfasalazine in have been refractory to aminosalicylate therapy. The majority of maintaining disease remission in patients with inactive UC.…”

Section: Moderately Severe Ucmentioning

confidence: 99%

Current Therapy of Inflammatory Bowel Disease in Children

Rufo

Bousvaros

2006

Pediatric Drugs

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Ulcerative colitis (UC) and Crohn disease (CD) are chronic intestinal inflammatory diseases that can present as bloody diarrhea, abdominal pain, and malnutrition. Collectively, these disorders are referred to as inflammatory bowel disease (IBD). All patients with IBD share a common pathophysiology. However, there are a number of developmental, psychosocial, and physiologic issues that are unique to the approximate, equals 20% of patients that present during childhood or adolescence. These include the possibility of disease-induced delays in linear growth or physical development, differences in drug dosing, and the changes in social and cognitive development that occur as children move from school-age years into adolescence and early adulthood. Gastroenterologists caring for these children must therefore develop an optimal regimen of pharmacologic therapies, nutritional management, psychologic support, and properly timed surgery (when necessary) that will maintain disease remission, minimize disease and drug-induced adverse effects, and optimize growth and development. This article reviews current approaches to the management of patients with UC and CD and highlights issues specific to the treatment of children with IBD. The principal medical therapies used to induce disease remission in patients with UC are aminosalicylates (for mild disease), corticosteroids (for moderate disease), and cyclosporine (ciclosporin) (for severe disease). If a patient responds to the induction regimen, maintenance therapies that are used to prevent disease relapse include aminosalicylates, mercaptopurine, and azathioprine. Colectomy with creation of an ileal pouch anal anastomosis (J pouch) has become the standard of care for patients with severe or refractory colitis and results in an improved quality of life in most patients. Therefore, the risks associated with using increasingly potent immunosuppressant agents must be balanced in each case against a patient's desire to retain their colon and avoid a temporary or potentially permanent ileostomy. Decisions about drug therapy in the management of patients with CD are more complex and depend on both the location (e.g. gastroduodenal vs small intestinal vs colonic), as well as the behavior of the disease (inflammatory/mucosal vs stricturing vs perforating) in a given patient. Induction therapies for CD typically include aminosalicylates and antibiotics (for mild mucosal disease), nutritional therapy (including elemental or polymeric formulas), corticosteroids (for moderate disease), and infliximab (for corticosteroid-resistant or fistulizing disease). Aminosalicylates, mercaptopurine, azathioprine, methotrexate, and infliximab can be used as maintenance therapies. Because surgical treatment of CD is not curative, it is typically reserved for those patients either with persistent symptoms and disease limited to a small section of the intestine (e.g. the terminal ileum and cecum) or for the management of complications of the disease including stricture or abdominal abscess. When surgery...

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“…Since gastrointestinal diseases may inter fere with the absorption of a drug and me tronidazole is employed therapeutically in bowel disease [3,6], we wanted to study the pharmacokinetics of this agent in various selected intestinal diseases. The patients with chronic inflammatory bowel diseases were at a quiescent stage during study and the patients with small bowel malabsorption were at a relatively stationary phase.…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics of Metronidazole in Patients with Enteric Disease Compared to Normal Volunteers

Bergan¹,

Bjerke²,

Fausa³

1981

Chemotherapy

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Tablets of 500 mg metronidazole were given to 24 patients with intestinal diseases and to 10 healthy volunteers. The diagnoses included coeliac disease, ulcerative colitis, jejunoileal shunt, ileostomy, and Crohn’s disease. Both normal subjects and patients exhibited considerable variation in serum metronidazole concentrations. This applied particularly to the patients who had somewhat slower absorption and later occurrence of serum peaks than did the normal subjects. No major deviation occurred within any of the diagnostic groups. All but the ileostomy patients exhibited a lag before apparent absorption. The individual peaks occurred after 1.5–2.0 h and was 12.7 ± 2.1 μg/ml in all disease groups, except the ileostomy patients who exhibited a mean of 16.2 μg/ml. In the healthy subjects, the mean peak was 12.1 ± 4.6 μg/ml. A major finding was the observation that the patients as a group had a higher total area under the serum curves (AUC) than the volunteers. The AUC of normal volunteers was 108.1 μg · h · ml^––¹ compared to 260.5 μg · h · ml^––1 in the patients with ileostomy and 147.6 μg · h · ml^––1 for the others. The higher AUC values in the ileostomy group were associated with longer serum half-life values. The serum half-life was 8.3 h in the normals, 11.9 h with ileostomy and 7.2 h in the remainder. The normal individuals and the patients with ulcerative colitis had higher rates of absorption, those with coeliac disease or ileostomy lower absorption rates than was found elsewhere. The relative volume of distribution (the distribution coefficient) was the same in the healthy individuals as in each patient group, except for the ileostomy patients. The total body clearance was 1.94 liters/h in ileostomy, 3.68 liters/h in the other patients, and 5.43 liters/h in the normal subjects.

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Metronidazole in the treatment of chronic proctitis: a controlled trial.

Cited by 40 publications

References 6 publications

Serum Concentrations of Metronidazole and Its Main Metabolite in Patients with Active Crohn’s Disease: Correlation with Disease Activity and Therapeutic Efficacy?

Serum Concentrations of Metronidazole and Its Main Metabolite in Patients with Active Crohn’s Disease: Correlation with Disease Activity and Therapeutic Efficacy?

Current Therapy of Inflammatory Bowel Disease in Children

Pharmacokinetics of Metronidazole in Patients with Enteric Disease Compared to Normal Volunteers

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