ANTIBIOTIC USE IN CROHNS-DISEASE - WHY AND HOW

On the assumption that bacteria in the gut may be a cause of symptoms and/or complications of Crohn's disease, various antibiotics are effic aciously employed in some affected patients. However, we do not know e xactly why and how they are helpful. A possible explanation is that on e or several bacterial species may have a primary role in the aetiolog y of Crohn's disease, but this is not supported by the data in our pos session. Another hypothesis is that intestinal bacteria may cause flar e-up of the disorder, either by inducing intestinal lesions or by an i nteraction with the immune system, but we know today that specific pat hogens can cause flares only in a minority of cases. On the contrary, there is considerable evidence that the intestinal microflora and its products may amplify and perpetuate inflammation in Crohn's disease. D espite the fact that few controlled trials have been conducted, and ha ve shown inconclusive results, antibiotics are widely employed for imp roving symptoms and for inducing remission of active phases. At presen t, a combination of metronidazole and ciprofloxacin, active against ma ny enteric bacteria, has proved to be effective in the treatment of Cr ohn's disease complications. This therapy also seems to be effective i n acute flares as an alternative to, or in combination with, corticost eroids.