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Antibiotics and azathioprine for the treatment of perianal fistulas in Crohn's disease
Author(s) -
Dejaco C.,
Harrer M.,
Waldhoer T.,
Miehsler W.,
Vogelsang H.,
Reinisch W.
Publication year - 2003
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.2003.01793.x
Subject(s) - azathioprine , medicine , antibiotics , immunosuppression , crohn's disease , gastroenterology , metronidazole , regimen , thiopurine methyltransferase , surgery , inflammatory bowel disease , disease , microbiology and biotechnology , biology
Summary Background : Antibiotics and thiopurines have been employed in the management of fistulizing Crohn's disease, although evidence of their efficacy is rare. Aim : To evaluate, in a prospective, open‐label study, the influence of antibiotics and azathioprine on the clinical outcome of perianal fistulas in patients with Crohn's disease. Methods : Fifty‐two patients entered the study, starting with an 8‐week regimen of ciprofloxacin (500–1000 mg/day) and/or metronidazole (1000–1500 mg/day). Seventeen patients had already received daily azathioprine (2–2.5 mg/kg) at enrolment, whereas in 14 patients azathioprine was initiated after 8 weeks of antibiotic treatment. Outcome was evaluated by Fistula Drainage Assessment and the Perianal Disease Activity Index at weeks 8 and 20. Results : Overall, 26 patients (50%) responded to antibiotic treatment, with complete healing in 25% of patients at week 8. The Perianal Disease Activity Index decreased significantly from 8.4 ± 2.9 to 6.0 ± 4.0 ( P < 0.0001). At week 20, the outcome was assessed in 49 patients (94%), 29 of whom (59%) had received azathioprine. Response was noted in 17 of the 49 patients (35%), with complete healing in nine patients (18%). Patients who received azathioprine were more likely to achieve a response (48%) than those without immunosuppression (15%) ( P = 0.03). The Perianal Disease Activity Index was closely associated with treatment response and perianal disease activity. Conclusion : Antibiotics are useful to induce a short‐term response in perianal Crohn's disease, and may provide a bridging strategy to azathioprine, which seems to be essential for the maintenance of fistula improvement.