It seems my blog got a bit longer holiday than the rest of us did.  But now it’s time to continue my series on the various allopathic treatments used for the management of Crohn’s disease.  In previous posts, I have discussed aminosalicylates, corticosteroids, and immunosuppressants.  Another tool frequently used by both MDs and alternative care providers is antibiotics.

Why antibiotics?  Crohn’s disease is, after all, an autoimmune disorder, not an infection.  While that is true, there is a significant amount of data showing that at it’s core, Crohn’s disease is an abnormal immune response to bacterial flora in the gut.  The thought then, is that by reducing the colonies of that flora, the immune system will reduce or cease its attack on the gut, thereby inducing remission.  Of course, killing off all the gut flora is no solution… our gut does not function properly without this symbiotic relationship, and we rely heavily on these colonies to help us digest the food we eat.  Interestingly, while antibiotics have been shown to be useful in managing Crohn’s disease, tests have shown them to be ineffective in managing ulcerative colitis.

While there exists a wide variety of antibiotics that could be used to manage Crohn’s, the most commonly prescribed are:

  • Metronidazole (Flagyl®)
  • Ciprofloxacin (Cipro®)

Both of these drugs are powerful, broad-spectrum antibiotics.  Metronidazole is often used when there are other Crohn’s related problems present, such as fistulas, frequent abcesses, or pouchitis (a condition that presents in patients who have had complete a complete colectomy and have had an ileal pouch constructed so as to remove the need for a colostomy).  Another common use for Metronidazole is as a bridge therapy, providing immediate relief during the onset period for aminosalicylates, such as azathioprine.  As useful and powerful a drug as Metro can be, its side effects are a limiting factor when considering it as a long-term therapy.  According to the Crohn’s and Colitis Foundation of America,

“Common side effects may include nausea, vomiting, loss of appetite, a metallic taste, diarrhea, dizziness, headaches, and discolored urine (dark or reddish brown). Another side effect of long-term use is tingling of the hands and feet, which may persist even after the drug is discontinued. If you develop such tingling, notify your doctor immediately. The medication should be stopped and not restarted.”

Because of these side effects, Cipro is generally preferred for long-term therapy.  Cipro’s side effects, while unpleasant, are rare, and include headache, nausea, vomiting and restlessness.  Most patients are able to tolerate Cipro for as long as it remains an effective treatment for them.

In addition to the side effects outlined above, there are various other considerations when using antibiotics as a maintenance therapy for Crohn’s.  Interactions can be problematic.  Metro interferes with the bodies ability to process alcohol, while Cipro is reactive with antacids and other supplements that contain calcium, iron or zinc.  Patients can be prone to sunburn.  Also, while it’s not a consideration for me, patients who are also taking warfarin will need to have their dosages adjusted accordingly, as antibiotics can interact with it and cause dangerous bleeding.

For a variety of reasons, my hope is that I will not need to use antibiotics as a maintenance drug to manage my Crohn’s.  For one, I don’t feel well when I take them, and the last thing I need is to have to take something every day that makes me feel oogy.  For another, while I am glad that antibiotics exist and believe that they are an important tool, I have concerns that long-term use of them would lead only to stronger, more virulent bacteria within my system.  I’m not entirely clear on what would prompt my MD to recommend antibiotics for my treatment, but should he choose to do so, I will have some questions for him, and possibly a request that we find a different course of treatment.

Ever since I started this series of articles, folks keep asking me, “What about Remicaid?”.  Seriously.  At least 15 times.  I promise…. I’ll get to it!  My next article will be on a class of drugs called biologics, and how they are used to treat autoimmune disorders.  So stay tuned!

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