Use of antibiotics in the treatment of active Crohn's disease: experience with metronidazole and ciprofloxacin

Ital J Gastroenterol Hepatol. 1998 Dec;30(6):602-6.


Background and aims: The use of antibiotics in the treatment of active Crohn's disease has recently increased on the assumption that enteral flora may play a role in the origin of symptoms and/or complications of Crohn's disease. The aim of this study was to evaluate retrospectively the efficacy of metronidazole and/or ciprofloxacin in the treatment of acute phases of Crohn's disease.

Methods: The clinical records of 233 inpatients seen at our clinic for active Crohn's disease and treated with metronidazole and/or ciprofloxacin (1 g daily each) during the period 1984-1996 were reviewed; the patients were divided into three groups according to antibiotic therapy. The primary criterion of success was the achievement of a complete or partial remission evaluated on the basis of the Simple Index; a secondary criterion of success was the efficacy of therapy on individual symptoms and signs.

Results: Similar rates of success were obtained with the three schemes of treatment: 70.6% with antibiotic combination, 72.8% with metronidazole, 69.0% with ciprofloxacin. The most frequent symptoms and signs such as diarrhoea, abdominal pain, fever, abdominal mass and abscesses improved in about 60% of patients in the three groups. Remission time after antibiotic treatment was about one year. Side effects requiring discontinuation of therapy occurred in about 20% of patients.

Conclusions: Metronidazole and ciprofloxacin seem to be useful in treating active phases of Crohn's disease. These results strongly support the important role of faecal flora in causing Crohn's disease symptoms.

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Infective Agents / adverse effects
  • Anti-Infective Agents / therapeutic use*
  • Ciprofloxacin / adverse effects
  • Ciprofloxacin / therapeutic use*
  • Crohn Disease / drug therapy*
  • Drug Therapy, Combination
  • Female
  • Humans
  • Male
  • Metronidazole / adverse effects
  • Metronidazole / therapeutic use*
  • Middle Aged
  • Remission Induction
  • Retrospective Studies


  • Anti-Infective Agents
  • Metronidazole
  • Ciprofloxacin