Use of antibiotics in the treatment of active Crohn's disease: experience with metronidazole and ciprofloxacin

Background and Aims. The use of antibiotics in the treatment of active Croh n's disease has recently increased on the assumption that enteral flora may play a role in the origin of symptoms and/or complications of Crohn's dise ase. The aim of this study was to evaluate retrospectively the efficacy of metronidazole and/or ciprofloxacin in the treatment of acute phases of Croh n's disease. Methods. The clinical records of 233 inpatients seen at our clinic for acti ve Crohn's disease and treated with metroninazole and/or ciprofloxacin (1 g daily each) during the period 1984-1996 were reviewed: the patients were d ivided into three groups according to antibiotic therapy. The primary crite rion of success was the achievement of a complete or partial remission eval uated on the basis of the Simple Index; a secondary criterion of success wa s the efficacy of therapy on individual symptoms and signs. Results. Similar rates of success were obtained with the three schemes of t reatment: 70.6% with antibiotic combination, 72.8% with metronidazole, 69.0 % with ciprofloxacin. The most frequent symptoms and signs such as diarrhoe a, abdominal pain, fever; abdominal mass and abscesses improved in about 60 % of patients in the three groups. Remis sion time after antibiotic treatme nt was about one year. Side effects requiring discontinuation of therapy oc curred in about 20% of patients. Conclusions. Metronidazole and ciprofloxacin seem to be useful in treating active phases of Crohn's disease. These results strongly support the import ant role of faecal flora in causing Crohn's disease symptoms.