Combination ciprofloxacin and metronidazole for active Crohn's disease
SL Greenbloom | AH Steinhart | GR Greenberg
experimental evidence underscores the contribution of
intestinal bacteria to the inflammatory process of Crohn's
disease. This open study examined the efficacy and safety
of combination ciprofloxacin and metronidazole for patients
with active Crohn's disease of the ileum and/or colon.
Seventy-two patients with active Crohn's disease of
the ileum (n=27), ileocolon (n=22) or colon (n=23) were
treated with ciprofloxacin 500 mg bid and metronidazole
250 mg tid for a mean of 10 weeks. Clinical remission
was defined as a Harvey-Bradshaw index of three points
or less; an index reduction of at least three points
indicated a clinical response. Clinical remission was
observed in 49 patients (68%), and 55 patients (76%)
showed a clinical response. A clinical response was
noted in 29 of 43 patients (67%) who were not taking
concurrent prednisone treatment and in 26 of 29 patients
(90%) receiving prednisone (mean dose of 15 mg/day).
A clinical response also occurred in a greater proportion
of patients with colonic disease, with or without ileal
involvement (84%), compared with patients with ileal
disease alone (64%), and in patients without resection
(86%) compared with those with previous resection (61%).
Five patients discontinued antibiotics because of adverse
events. After a mean follow-up of nine months, clinical
remission was maintained in 26 patients off treatment
and in 12 patients who continued antibiotic therapy.
Ciprofloxacin in combination with metronidazole is well
tolerated and appears to play a beneficial role in achieving
clinical remission for patients with active Crohn's
disease, particularly when there is involvement of the