Antibiotic therapy for treatment in relapse of intestinal Crohn's disease

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Abstract
A prospective randomized trial of 1 mo. antimicrobial therapy was undertaken for patients with symptomatic relapse of Crohn''s disease. Criteria for entry included 2 major symptoms: fever, abdominal pain, diarrhea, weight loss, abdominal mass or complications (excluding perianal disease); and 2 hematologic abnormalities: Hb, erythrocyte sedimentation rate, albumin, C-reactive protein (CRP), Fe, or total Fe-binding capacity. Patients were monitored for the aforementioned clinical and hematologic (Hb, albumin, CRP)parameters over 6 wk and for changes in fecal flora. Randomization was to 4 groups: metronidazole alone (M), co-trimoxazole alone (C), metronidazole and cotrimoxazole (C plus M), or double placebo (P). Seventy-two patients entered the study (18 = M, 16 = C, 21 = C plus M, 17 = P). After 2 wk, improvement was reported as follows: M = 67%, C = 17%, C plus M = 71%, P = 35%. In the M group, 2 patients required surgery and 1 had troublesome side effects. In the C group, 2 had side effects. In the C plus M group, 4 had troublesome side effects and 2 of the placebo group (P) required operation. By 4 wk, there was no difference in response among the groups: (M = 44%, C = 62%, C plus M = 57%, P = 41%). Antimicrobials had no effect on fecal flora or hematologic parameters. These results indicate that antimicrobials have little therapeutic potential for relapse of intestinal Crohn''s disease.