Abstract
A prospective double blind controlled trial was undertaken to examine the role of metronidazole as an adjunct to corticosteroids in the management of severe ulcerative colitis. Thirty nine patients with severe ulcerative colitis were randomised on admission to hospital to receive either intravenous metronidazole 500 mg eight hourly (19 patients) or an identical intravenous placebo (20 patients). The two groups were similar with respect to age, sex, and the extent of colitis. In addition all patients received a standard intravenous regimen consisting of methyl prednisolone 16 mg six hourly and parenteral nutrition together with a twice daily hydrocortisone 100 mg enema. Treatment was continued for five days when the patients were formally assessed. Fourteen of 19 patients (74%) receiving metronidazole and 14/20 (70%) receiving placebo were substantially improved, or in remission at the end of five days. Five patients treated with metronidazole and six with placebo had no improvement and all proceeded to urgent colectomy with no operative mortality. There were three late deaths, one in the metronidazole and two in the placebo group. These results do not support the routine use of intravenous metronidazole in the treatment of severe ulcerative colitis.
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- Bolton R. P., Sherriff R. J., Read A. E. Clostridium difficile associated diarrhoea: a role in inflammatory bowel disease? Lancet. 1980 Feb 23;1(8165):383–384. doi: 10.1016/s0140-6736(80)90940-x. [DOI] [PubMed] [Google Scholar]
- Czaja A. J., Wolf A. M., Baggenstoss A. H. Laboratory assessment of severe chronic active liver disease during and after corticosteroid therapy: correlation of serum transaminase and gamma globulin levels with histologic features. Gastroenterology. 1981 Apr;80(4):687–692. [PubMed] [Google Scholar]
- DICK A. P., GRAYSON M. J., CARPENTER R. G., PETRIE A. CONTROLLED TRIAL OF SULPHASALAZINE IN THE TREATMENT OF ULCERATIVE COLITIS. Gut. 1964 Oct;5:437–442. doi: 10.1136/gut.5.5.437. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dickinson R. J., O'Connor H. J., Pinder I., Hamilton I., Johnston D., Axon A. T. Double blind controlled trial of oral vancomycin as adjunctive treatment in acute exacerbations of idiopathic colitis. Gut. 1985 Dec;26(12):1380–1384. doi: 10.1136/gut.26.12.1380. [DOI] [PMC free article] [PubMed] [Google Scholar]
- George R. H. A micro-method for detecting toxins in pseudomembranous colitis. J Clin Pathol. 1979 Mar;32(3):303–304. doi: 10.1136/jcp.32.3.303. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Grove D. I., Mahmound A. A., Warren K. S. Suppression of cell-mediated immunity by metronidazole. Int Arch Allergy Appl Immunol. 1977;54(5):422–427. doi: 10.1159/000231857. [DOI] [PubMed] [Google Scholar]
- Hafiz S., Oakley C. L. Clostridium difficile: isolation and characteristics. J Med Microbiol. 1976 May;9(2):129–136. doi: 10.1099/00222615-9-2-129. [DOI] [PubMed] [Google Scholar]
- Jewell D. P. Diagnosis and medical treatment of ulcerative colitis. Br J Hosp Med. 1982 May;27(5):456–462. [PubMed] [Google Scholar]
- TRUELOVE S. C., WATKINSON G., DRAPER G. Comparison of corticosteroid and sulphasalazine therapy in ulcerative colitis. Br Med J. 1962 Dec 29;2(5321):1708–1711. doi: 10.1136/bmj.2.5321.1708. [DOI] [PMC free article] [PubMed] [Google Scholar]
- TRUELOVE S. C., WITTS L. J. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J. 1955 Oct 29;2(4947):1041–1048. doi: 10.1136/bmj.2.4947.1041. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Truelove S. C., Jewell D. P. Intensive intravenous regimen for severe attacks of ulcerative colitis. Lancet. 1974 Jun 1;1(7866):1067–1070. doi: 10.1016/s0140-6736(74)90552-2. [DOI] [PubMed] [Google Scholar]