Antibiotics in Crohn's disease and ulcerative colitis
- antibacterials, such as metronidazole and ciprofloxacin, may be prescribed in the treatment of fistulating Crohn's disease to treat accompanying abscesses or in perianal Crohn's disease or sepsis (1)
- antibiotics, including metronidazole, are indicated in
- the treatment of symptoms attributable bacterial overgrowth
- septic complications
- perineal disease
- significant side-effects of metronidazole include peripheral neuropathy if used long term (over three months), a bad taste in the mouth and a disulfiram-like interaction with alcohol
NICE suggest:
- to maintain remission in people with ileocolonic Crohn's disease who have had complete macroscopic resection within the last 3 months, consider azathioprine in combination with up to 3 months' postoperative metronidazole
The routine use of long term antibiotics in the absence of suspected sepsis is not supported by evidence. (2)
Reference
- NICE. Crohn’s disease: management. NICE guideline NG129. Published May 2019
- Townsend CM, Parker CE, MacDonald JK, et al. Antibiotics for induction and maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2019 Feb 7;(2):CD012730.
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