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 24 February 2018

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Ciprofloxacin with infliximab for treatment of perianal fistulae

A combination of ciprofloxacin and infliximab tends to be more effective for the treatment of perianal fistulae in Crohn's disease than infliximab alone, reports the most recent issue of Alimentary Pharmaology and Therapeutics.

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

Dr West and colleagues from Rotterdam, the Netherlands, designed a study in order to evaluate the effect of combined ciprofloxacin and infliximab in perianal Crohn's disease.

In this double-blind placebo-controlled study, the researchers randomly assigned patients 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 the research team followed them up for 18 weeks.

The researchers used clinical response as the primary end-point, defined as a 50% or greater reduction from baseline in the number of draining fistulae.

Response was 73% in the ciprofloxacin group and 39% in the placebo group
Alimentary Pharmacology and Therapeutics

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.

In total, the researchers included 24 patients but 2 discontinued treatment.

At week 18, the researchers found that the response was 73% in the ciprofloxacin group and 39% in the placebo group.

Using logistic regression analysis, the research team noted that patients treated with ciprofloxacin tended to respond better.

In addition, the researchers found that the Perianal Disease Activity Index score only improved in the ciprofloxacin group.

3-dimensional endoanal ultrasonography improved in 3 patients with a clinical response.

Dr West concluded, "A combination of ciprofloxacin and infliximab tended to be more effective than infliximab alone."

Alimentary Pharmacology & Therapeutics; 2004: 20 (11-12), 1329-1336.
15 December 2004

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