Objectives: The aim of this study was to evaluate the role of metronidazole and tobramycin as an adjunct to corticosteroids in acute, severe ulcerative colitis.
Methods: Thirty-nine consecutive patients with severe ulcerative colitis were randomized on admission to the hospital to receive intravenously either metronidazole (0.5g tid) and tobramycin (4 mg/kg tid) (n = 19), or placebo (n = 20). In addition, they were given parenteral nutrition, intravenous hydrocortisone (100 mg qid) and hydrocortisone enemas (100 mg bid). All patients were assessed after 10 days of continuous treatment, or at any time a severe complication occurred.
Results: Twelve of 19 patients (63.15%) treated with antibiotics and 13/20 patients (65%) with placebo showed substantial improvement. Seven patients in each group did not improve (n = 9), or developed complications (n = 5) and underwent emergency colectomy without perioperative deaths or late deaths.
Conclusions: These results do not support the routine use of intravenous tobramycin and metronidazole in the treatment of severe ulcerative colitis.