Metronidazole Therapy for Perineal Crohn's Disease: A Follow-Up Study

Brandt, Lawrence J.; Bernstein, Leslie H.; Boley, Scott J.; Frank, Michael S.

doi:10.1016/s0016-5085(82)80332-6

Cited by 444 publications

(129 citation statements)

References 9 publications

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“…These fistulae may connect adjacent loops of bowel (enteroenteric), the bowel to the skin (enterocutaneous), the bowel to the bladder (enterovesical), the bowel to the vagina (enterovaginal), and the bowel to the perianal region (perianal fistulae). Medications reported to be of benefit for reducing fistula drainage or fistula closure in uncontrolled studies include metronidazole (26)(27)(28), 6MP and its prodrug AZA (29)(30)(31)(32)(33)(34), and intravenous CYA (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Efficacy for AZA and 6MP has been confirmed to some extent by post hoc analysis of fistula improvement/ closure as a secondary endpoint in placebo-controlled trials (35)(36)(37)(38)(39).…”

Section: Discussionmentioning

confidence: 99%

Combination therapy with oral tacrolimus (FK506) and azathioprine or 6-mercaptopurine for treatment-refractory Crohn's disease perianal fistulae

2007

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Summary:Our aim was to report the clinical experience with combination treatment using tacrolimus and either azathioprine (AZA) or 6-mercaptopurine (6MP) in patients with Crohn's disease (CD) perianal fistulae. The medical records of all patients with Crohn's disease perianal fistulae seen at the Mayo Clinic from 1996-1998 who were treated with tacrolimus were reviewed. Clinical response was classified as: complete response, partial response, and nonresponse. Eleven patients were treated with oral tacrolimus for a mean duration of 22 weeks. The initial oral dose of tacrolimus ranged from 0.15 to 0.31 mg/kg/day. Azathioprine or 6MP was continued in combination with tacrolimus in seven patients and initiated simultaneously with tacrolimus in four patients. All patients improved clinically, seven had a complete response, and four had a partial response. The mean time to initial improvement was 2.4 weeks, and the mean time to complete response was 12.2 weeks. The most frequent adverse events were nausea, paresthesias, nephrotoxicity, and tremor. Patients with nephrotoxicity had a significantly higher mean initial tacrolimus dose (0.3 1 mg/kg/day) compared with patients who did not have nephrotoxicity (0.25 mgkg/day) (p = 0.035); however, there was not a statistically significant association between the starting dose or mean blood level and clinical response. Combination therapy with oral tacrolimus and AZA or 6MP may be effective treatment for CD perianal fistulae. Higher initial tacrolimus doses increase the risk of nephrotoxicity without improving clinical response.

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Section: Discussionmentioning

confidence: 99%

Combination therapy with oral tacrolimus (FK506) and azathioprine or 6-mercaptopurine for treatment-refractory Crohn's disease perianal fistulae

2007

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“…A follow-up study showed that metronidazole continued to be effective over longer periods of time (up to 12 months in 16 patients). 35 However, disease frequently recurred when the metronidazole dose was decreased or discontinued. Another open-label study also showed efficacy of metronidazole (20 mg/kg/day) in the treatment of perianal fistulas, with a 20-fold decrease in draining fistulas and a 50% decrease in fistulous openings.…”

Section: Perianal Crohn's Diseasementioning

confidence: 99%

Use of antibiotics in the treatment of inflammatory bowel disease

Perencevich

Burakoff

2006

Inflammatory Bowel Diseases

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An increasing amount of evidence suggests that enteric flora may have a role in the pathogenesis of inflammatory bowel disease (IBD). Patients with IBD appear to have an altered composition of luminal bacteria that may provide the stimulus for the chronic inflammation characterizing IBD. The suspected role of bacteria in the pathogenesis of IBD provides the rationale for using agents, such as antibiotics, that alter the intestinal flora. However, there remains much uncertainty about the optimal use of antibiotics in the treatment of Crohn's disease, ulcerative colitis, and pouchitis. This article reviews the literature and presents a clinical model for the use of antibiotics in IBD.

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“…Metronidazole alone or in combination with steroids has been the most effective treatment, with a success rate of 87.5%. 5 Other interventions such as systemic, intralesional or topical corticosteroids, sulfasalazine, azathioprine, and infliximab have all been used, with varying response; infliximab is used for more recalcitrant cases. 6 Refractory cases may require vulvectomy, but overall management should include a multidisciplinary approach.…”

Section: Discussionmentioning

confidence: 99%