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Long-Term Antibiotic Treatment Effective for Crohn's Disease

Clin Infect Dis 2010;50:473-480.

Long-term treatment with clofazimine or nitroimidazoles may help control Crohn's disease, according to the authors of a systematic review and meta-analysis.

Several bacteria have been implicated in Crohn's disease, but antibiotics are currently recommended only for certain complications, such as sepsis or perianal disease, the researchers note in the February 15th issue of Clinical Infectious Diseases.

The meta-analysis, by Dr. Martin Feller from the University of Bern, Switzerland, and colleagues, pooled data from 16 randomized, placebo-controlled trials involving a total of 865 patients, in order to assess the effectiveness of long-term antibiotic treatment for Crohn's disease. The outcomes were remission (in patients with active disease) or relapse (in patients with inactive disease).

The studies examined 13 different treatment regimens, ranging from single drugs to combinations of up to 4 drugs. The median treatment duration was 6 months. Four studies specifically excluded the use of steroids; the others either included them or allowed them to be added when indicated.

The quality of reporting of study methods was generally low, the authors report.

Three trials of nitroimidazoles (206 patients) showed a significant benefit (odds ratio, 3.54), the researchers note, as did 4 trials of clofazimine (322 patients; OR, 2.86).

The number of patients with active disease needed to treat to keep 1 additional patient in remission was 3.4 for nitroimidazoles and 4.2 for clofazimine. For inactive disease, the number needed to treat was 6.1 for nitroimidazoles and 6.9 for clofazimine.

One trial of ciprofloxacin, involving 47 patients, showed a benefit (OR, 11.3), but with a wide confidence interval.

Three trials involving 107 patients showed no benefit from treatment with classic anti-tuberculosis drugs.

The 4 studies of clarithromycin alone or in combination with other antibiotics (287 patients) were highly heterogeneous and could not be combined in the meta-analysis, according to the report.

"We believe that further research is justified to better define the role of antibacterial agents and combination regimens in Crohn's disease," the investigators say. "Future studies should focus on clofazimine, alone or in combination with a macrolide and a rifamycin, as well as in combination with a nitroimidazole, and perhaps ciprofloxacin."
Cipro and Levaquin have left me with persistant adverse effects. Folks who use them should be careful to monitor their reaction to these antibiotics since both are commonly prescribed for flares, perianal abscess, and sepsis.
I was on Cipro & Flagyl for about 2 weeks, much shorter than the 6 month median duration cited in the report. No real adverse effects, but no help either. Worst part was I could not enjoy red wine while on the Flagyl, which is said by some (denied by others) to have effects like the anti-alcoholism drug Antabuse.
I used the antibiotic thinking when using acidified Chlorine Dioxide as a treatment, otherwise known as Miracle Mineral Solution.

I wanted to clear out the bad bacteria in my intestinal tract, but obviously I did not have antibiotics at my disposal, and I am leery of any fluoroquinolone antibiotics since I do know people that have been damaged by them, myself included.

I found the properties of chlorine dioxide fit the bill as it is a selective oxidizer that will not harm non-acidic bacteria. Luckily, most bacteria that is not thought beneficial to humans are acidic.

While I did not have all of the assurances of safety I would have liked, thousands had used it before me without any serious problems for other conditions.

It was the one treatment out of many I tried that brought my inflammation and symptoms to a halt after four weeks of use. I would not want to use it for months or years, but it is far safer than an anti-biotic regimen in my opinion. For twenty five dollars and plenty left over for future use, it was probably the best bargain in a treatment I have ever had.

I used to take flagyl long term, but ended up with peripheral neuropathy, which felt like I had 3rd degree burns on my feet and i had electric jotls in my feet too. My hands were not affected. So I was switched to Cipro... which until today, I have called my magic formula until it dawned on me, that I am continually getting injured after minimal physical activity like hiking, or lifting light weights, doing squats or lunges. I can literally feel things pop like rubber bands snapping. I've been doing some research and was not surprised to find this can be a common side effect of cipro. I'll be going to the Dr. to change my health plan asap! Also, horrific nightmares and other feelings of just not being quite right.

Did or does anyone else have similar probs?