IngentaConnect Clinical and endosonographic effect of ciprofloxacin on the treat...

Authors: West, R. L.¹; Woude, C. J.¹; Hansen, B. E.¹; Felt-Bersma, R. J. F.¹; Tilburg, A. J. P.²; Drapers, J. A. G.³; Kuipers, E. J.¹

Source: Alimentary Pharmacology & Therapeutics, Volume 20, Numbers 11-12, December 2004 , pp. 1329-1336(8)

Publisher: Blackwell Publishing

Abstract:

Summary Background

: Ciprofloxacin is effective in perianal Crohn's disease but after treatment discontinuation symptoms reoccur. Infliximab is effective but requires maintenance therapy. Aim

: To evaluate the effect of combined ciprofloxacin and infliximab in perianal Crohn's disease. Methods

: A double-blind placebo-controlled study was conducted. Patients were randomly assigned to receive 500-mg ciprofloxacin twice daily or a placebo for 12 weeks. All patients received 5-mg/kg infliximab in week 6, 8 and 12 and were followed for 18 weeks. Primary end-point was clinical response, defined as a 50% or greater reduction from baseline in the number of draining fistulae. Secondary end-points were the change in Perianal Disease Activity Index and hydrogen peroxide enhanced three-dimensional endoanal ultrasonography findings. Analysis was by intention-to-treat. Results

: Twenty-four patients were included but two discontinued treatment. At week 18, response was 73% (eight of 11) in the ciprofloxacin group and 39% (five of 13) in the placebo group (P = 0.12). Using logistic regression analysis patients treated with ciprofloxacin tended to respond better (OR = 2.37, CI: 0.94-5.98, P = 0.07). The Perianal Disease Activity Index score only improved (P = 0.008) in the ciprofloxacin group. Three-dimensional endoanal ultrasonography improved in three patients with a clinical response. Conclusions

: A combination of ciprofloxacin and infliximab tended to be more effective than infliximab alone.

Document Type: Research article

DOI: 10.1111/j.1365-2036.2004.02247.x

Affiliations: 1: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam 2: Department of Internal Medicine, St Franciscus Gasthuis, Rotterdam 3: Department of Internal Medicine, Ziekenhuis Walcheren, Vlissingen, The Netherlands

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Clinical and endosonographic effect of ciprofloxacin on the treatment of perianal fistulae in Crohn's disease with infliximab: a double-blind placebo-controlled study