A prospective randomized controlled trial of intravenous ciprofloxacin as an adjunct to corticosteroids in acute, severe ulcerative colitis

Background: The role of antibiotics in the treatment of ulcerative colitis is controversial. This study aims at assessing the therapeutic role of cipr ofloxacin as an adjunct to corticosteroids in acute severe ulcerative colit is. Methods: In this prospective, randomized, double-blind, placebo-control led trial, 55 consecutive patients fulfilling the criteria of Truelove and Wilts for severe ulcerative colitis were randomized on admission to the hos pital to receive intravenously ciprofloxacin (400 mg b.i.d.) (n = 29) or pl acebo (n = 27). All patients received parenteral nutrition, intravenous hyd rocortisone (100 mg q.i.d.) and hydrocortisone enemas (100 mg b.i.d.). Pati ents were assessed after 10 days of continuous treatment, or at any time a severe complication occurred. Results: At study entry, there were no signif icant differences between treatment groups in any patient or disease-relate d parameter. Twenty-three of 29 patients (79.3%) treated with ciprofloxacin and 20 of 26 patients (77%) treated with placebo showed substantial improv ement and were given oral steroids (P > 0.1). Six patients in each group di d not improve (n = 10) or developed complications (n = 2). Nine of these 12 patients underwent emergency colectomy; three patients consented to receiv e intravenous cyclosporin but did not achieve remission of colitis and they underwent elective colectomy. There were no perioperative or late deaths. Conclusions: A short course of intravenous ciprofloxacin does not seem to a ugment the effect of corticosteroids for patients with acute, severe ulcera tive colitis.