• Welcome to Crohn's Forum, a support group for people with all forms of IBD. While this community is not a substitute for doctor's advice and we cannot treat or diagnose, we find being able to communicate with others who have IBD is invaluable as we navigate our struggles and celebrate our successes. We invite you to join us.

nausea with flagyl\cipro and/or MTX

Posting again in the General discussion. Thank you for this great forum, it has been very helpful so far with lots of information. Here is some background with 16 year kid with Crohn’s disease, any advice or opinions very much appreciated.

- Remicade April 2016 to July 2019. worked intially but loss of response over time, not fully effective
- Humira - August 2019 to Feb 2020 - Did not work even with increase dosage frequency from 2 weeks to each week. Tried Prednisone three times during this time. First time short course of one week of 40mg/day. No tapering. Second time started with 40 mg and tapered over 3 months. Third time low maintenance dose 15 mg with tapering over a month.
- Tried Methotrexate+Remicade again in March-April 2020. Did not see any improvement and oral Methotrexate may be giving pain in the lower abdomen.
- May 2020- Switched to Methotrexate + Stelara. MTX by injection. Still was having loss of appetite and pain in lower-right abdomen. So far 5 weeks into the treatment plan with weekly MTX and 2 weeks ago today Stelara induction infusion.
- Two dosage of Injectfer for Iron infusion over the period of two weeks, two weeks ago.
- Last week, checked with for severe pain in TI area. Resulted into the hospitalization to do MRE for suspicion of abscess and to determine any nutritional supplement needs for weight loss. MRE came same as what was in the March MRE. No significant abscess or any drainage of fluid needed. inflammation with some narrowing and some small fluid in TI area, No blocking of walls. There was one area with soft tissue in the glute. Hence it was determined to start Antibiotics as there could be possibility of infection.
- Antibiotics - Flagyl (400mg/8hrs) by IV and Cipro (400mg/12 hrs) orally started on Friday(06/18). scheduled Methotrexate was given by injection (taking that every week from the last 5 weeks.
- Saturday afternoon was discharge from the hospital resulting into Flagyl switch to orally. was okay on Saturday
- Sunday morning vomiting 3 times and super nausea resulting into no intake of food and low fever with mild dehydration
- Monday severe nausea continued resulting into Hospitalization again. Since oral antibiotics are not tolerated, IV antibiotics are started

Current problems are extreme nausea with antibiotics and crohns issues are inflammation in the TI area with some fluid build up and soft tissue in the gluteal area.

What can be done to reduce nausea for short term and any other opinions suggestions for short term and long term. Thank you for reading.
We are feeling that lot of his issues started after MTX was added and the nausea got severe after adding antibiotics . How do we determine if MTX is helping or adding more issues? Skip couple of doses until abx dose is done and watch if there is any improvement? Or drop MTX and add steroids until he starts improving and then add MTX if needed?

Currently he is not on any steroid, steroid was stopped in March. Possible options are either add solumedrol or entocort. They have reservations on starting prednisone because of covid-19

And is it usual practice to have MTX with Stelara? Can it be added later if needed?