COMBINATION CIPROFLOXACIN AND METRONIDAZOLE IN SEVERE PERIANAL CROHNS-DISEASE

Severe perianal involvement in Crohn's disease often is refractory to both medical and surgical treatment. The object of is study was to rev iew retrospectively the response of patients with severe perianal Croh n's disease to a combination of ciprofloxacin and metronidazole. Fourt een patients (seven males, seven females, mean age 34.8 years) were tr eated consecutively with a combination of ciprofloxacin (1000 to 1500 mg/day) and metronidazole (500 to 1500 mg/day). All had quiescent bowe l disease. Perianal disease had been present for a mean of 28.4 months . Six patients were on metronidazole at presentation and seven had had previous perianal surgery (mean of three operations per patient). All patients were symptomatic. Nine patients had complex fistula, six had anal canal ulceration, one had a rectovaginal fistula and five had di scharging abscesses. Seven patients had multiple perianal lesions. Phy sician assessment at a mean of 12 weeks after commencing therapy revea led three patients healed, nine improved, one unchanged and one worsen ed, requiring a defunctioning stoma. Thus, 12 of 14 (85%) showed benef it from combination therapy. Patients have been followed a mean of 6.4 months since commencing therapy. Five patients had therapy stopped at 12 weeks and have not required further treatment, six patients requir ed continuous low dose therapy (ciprofloxacin 500 to 1000 mg/day plus metronidazole 500 to 750 mg/day), three patients stopped therapy at 12 weeks but subsequently restarted therapy because of relapse. Thus, ni ne of 14 patients (64%) required continuous or repeat therapy. At pres ent, seven patients have quiescent, six have mild, and one has moderat e perianal disease. These results suggest that ciprofloxacin plus metr onidazole may be effective in severe perianal Crohn's disease.