Metronidazole Plus Ciprofloxacin Therapy for Active Crohn's Disease

Abstract

Objective The aim of this study was to investigate the efficacy of metronidazole plus ciprofloxacin for the treatment of Japanese patients with active Crohn's disease. Methods and Patients Seven patients (counting one patient twice with 2 enrollments at a 5-month interval) with a flare-up of Crohn's disease were enrolled. While continuing the baseline treatment under which the patients relapsed, they received metronidazole 250 mg twice (4 patients) or three times (3 patients) daily plus ciprofloxacin 200 mg three times daily for 4 weeks. The efficacy was evaluated by the changes in the assessment score of IOIBD, the International Organization for the Study of Inflammatory Bowel Disease, and the inflammation markers: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell count. ResultsMetronidazole plus ciprofloxacin decreased the CRPin seven patients and the IOIBDscore in six patients. Significant differences were detected in these parameters at weeks 2 and 4 compared with baseline. Five of the patients achieved normalization of CRPand a reduction of the IOIBDscore to zero or one. Although one patient complained of taste disturbance, no other adverse events occurred and all patients completed the 4 weeks of study medication. Conclusion The addition of metronidazole plus ciprofloxacin could be a useful intervention for the treatment of Japanese patients with active Crohn's disease. (Internal Medicine 42: 318-321, 2003)

Inflammatory Bowel Disease Therapies and Gut Function in a Colitis Mouse Model

“…These antibiotics are used in clinical practice for controlling symptoms and preventing septic complications in patients with active CD [24, 31]. They are known to alter the bacterial composition of the intestine by changing the balance between different bacterial groups [32, 33].…”

Meta-analysis of ciprofloxacin in treatment of Crohn's disease

“…An uncontrolled trial (22) indicated that cipro in combination with metro was well-tolerated and beneficial for achieving clinical remission for patients with active CD, particularly when there was involvement of the colon. A study (23) in Japan found that combination therapy of cipro and metro for four weeks significantly decreased the C-reactive protein in all the patients involved. In a randomized non-placebo controlled trial (24) involving 40 CD patients, complete remission was observed in 56% patients treated with cipro and 55% patients treated with mesalazine.…”

Gut Microbiota and Inflammatory Bowel Disease: The Role of Antibiotics in Disease Management

“…75 Indeed, induction of clinical remission of CD with antibiotics has yielded mixed findings in a number of independent studies, with only a small number of studies demonstrating significant differences between antibiotics and placebo (Table 3); again, these studies all had differences in duration of treatment (from 4 weeks to 6 months), with different antibiotics used in a number of combinations. [76][77][78][79][80][81][82][83][84][85] Results of a retrospective study of patients receiving the nonsystemic antibiotic rifaximin, both in traditional and extended intestinal release forms, showed that rifaximin induced remission and response compared with placebo. 83,84,86 In contrast with systemic antibiotics, which are associated with a greater percentage of AEs than placebo (eg, abdominal pain, nausea, vomiting, vaginal candidiasis, dizziness, and taste disturbance), [77][78][79]81 rifaximin had fewer disturbances mostly limited to the GI tract (eg, nausea, flatulence).…”