[Metronidazole in the treatment of Crohn disease. Results of a controlled randomized prospective study]

In a controlled, randomised prospective study on 52 patients with active ileocolitis Crohn (n = 44) or discharging fistulae (n = 18) metronidazole monotherapy was compared with a combination of cortisone and salazosulfapyridine, and of cortisone, salazosulfapyridine and metronidazole, respectively. Therapeutic efficacy was judged by various clinical, laboratory and haematological activity parameters, as well as by closure of discharging fistulae. Although analysis of variance showed no significant differences in the changes in individual activity parameters between the three groups, the combination of cortisone, salazosulfapyridine und metronidazole normalised the nine activity parameters more often than the other treatments. Metronidazole alone led to complete closure of discharging fistulae in 40% of cases and produced a clear reduction in fistula discharge in a further 20%. A more effective fistulae therapy could not be achieved even when combined with cortisone and salazosulfapyridine. In view of the dose-related serum concentrations of metronidazole and its minimal inhibitory concentration for anaerobic bacteria, the dose of metronidazole in ileocolitis Crohn should not be less than 400 mg/d. After evaluation of all findings, and taking into account the neurological side effects of long-term metronidazole therapy, the main indications for metronidazole in ileocolitis are failure of cortisone and salazosulfapyridine as well as discharging fistulae.