Combination of Ciprofloxacin and Metronidazole in Severe Perianal Crohn’s Disease

Abstract

MJ SOLOMON, RS MCLEOD, Bl O'CONNOR, AH STEINHART, GR GREENBERG, Z COHEN. Combination ciprofloxacin and metronidazole in severe perianal Crohn's disease. Can J Gastroenterol 1993;7(7):571-573. Severe perianal involvement in Crohn's disease often is refractory to both medical and surgical treatment. The object of this study was to review retrospectively the response of patients with severe perianal Crohn's disease to a combination of ciprofloxacin and metronidazole. Fourteen patients (seven males, seven females, mean age 34.8 years) were treated consecutively with a combination of ciprofloxacin (1000 to 1500 mg/day) and metronidazole (500 to 1500 mg/day). All had 4uiescent bowel 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 discharging abscesses. Seven patients had multiple perianal lesions. Physician assessment at a mean of 12 weeks after commencing therapy revealed three patients healed, nine improved, one unchanged and one worsened, requiring a defunctioning stoma. Thus, 12 of 14 (85%) showed benefit 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 required continuous low dose therapy (ciprofloxacin 500 to 1000 mg/day plus metronidazole 500 to 750 mg/day), three patients stopped therapy at 12 weeks hut subsequently restarted therapy because of relapse. Thus, nine of 14 patients (64%) required continuous or repeat therapy. At present, seven patients have quiescent, six have mild, and one has moderate perianal disease. These results suggest that ctprofloxacin plus metronidazole may be effective in severe pcrianal Crohn's disease. (Pour resume , voir page 572)