Am J Gastroenterol  1996 Feb;91(2):328-32 

An antibiotic regimen for the treatment of active Crohn's disease: a randomized,

controlled clinical trial of metronidazole plus ciprofloxacin.

Prantera C, Zannoni F, Scribano ML, Berto E, Andreoli A, Kohn A, Luzi C.

Division of Gastroenterology, Ospedale Nuovo Regina Margherita, Rome, Italy.

OBJECTIVES: Bacteria in the gut lumen may play a role in the etiology and/or the

symptoms of Crohn's disease (CD). Although various antibacterial drugs have been

employed in clinical practice, few controlled trials have been conducted, and

those had conflicting results. The aim of this study was to investigate the

efficacy and the safety of a combination of metronidazole and ciprofloxacin,

compared with methylprednisolone, in treating 41 consecutive patients with

active CD. METHODS: Eligible patients, 13 men and 28 women, mean age 38 yr, were

randomly allocated to receive, for 12 wk, ciprofloxacin 500 mg twice daily plus

metronidazole 250 mg four times daily or methylprednisolone 0.7-l mg/kg/day,

with variable tapering to 40 mg, followed by tapering of 4 mg weekly. RESULTS:

Ten of the 22 antibiotic patients (45.5%) and 12 of the 19 steroid patients

(63%) obtained clinical remission (Crohn's Disease Activity Index < or = 150) at

the end of the 12-wk study (p = NS). Five patients on antibiotics (22.7%) and

five patients on steroids (26.3%) were considered treatment failures because of

deterioration or persistent symptoms. Six patients receiving antibiotics (27.3%)

and two on steroids (10.6%) were withdrawn from the trial because of side

effects. One patient on antibiotics was not compliant. CONCLUSIONS:

metronidazole and ciprofloxacin could be an alternative to steroids in treating

the acute phase of CD.