What you should know about the treatment of Crohn’s disease with antibiotics

Crohn’s treatment usually involves medications, and antibiotics are often the first to be prescribed. Learn about the advantages and disadvantages of these medications.

When you have an inflammatory bowel disease, you may feel like there is a war in your gut. And in some respects, that’s true: inside the gastrointestinal system, there is a balance of good and bad bacteria. When that balance tilts, bad guys can take over, resulting in abdominal cramps, diarrhea, and other unpleasant symptoms.

The precipitation of this bacterial war can be Crohn’s disease, a chronic condition that causes inflammation in the gastrointestinal tract. At this point, the experts are not sure of the exact cause of Crohn’s, but the bacteria seem to be involved. That, in turn, can affect Crohn’s treatment.

“There is a debate among experts about how much of a role the bacteria that live in our gut play to cause inflammation in Crohn’s disease,” says Karlee Ausk, MD, gastroenterologist in Swedish Gastroenterology, part of the Swedish Medical Center in Seattle . “We know that when Crohn’s disease is active, the wall of the colon is a bit permeable, so bacteria can get in there.”

And while the underlying cause of Crohn’s disease is unknown, research points out that genetics, bacteria, and a defective immune system are involved. Now, scientists at Case Western Reserve University in Cleveland have found another clue to fit this disconcerting condition: a fungus called Candida tropicalis.

In a study published in September 2016 in the journal mBio, researchers examined fecal samples from people with Crohn’s, their families and residents living in the vicinity. People with Crohn’s showed higher amounts of the bacteria Serratia marcescens and Escherichia coli (E. coli) as well as Candida tropicalis, which interacted with each other to produce a biofilm – a viscous film of bacteria in the body that can attach to the intestines and It is thought to generate inflammation. Although these findings shed new light on Crohn’s, there are current processes to keep the symptoms under control.

To counteract excessive growth of bacteria and yeast and relieve Crohn’s symptoms, your doctor may prescribe antibiotics as a treatment.

“By using Crohn’s antibiotics, the hope is we can lessen the bacteria that have invaded weakened tissue and change the composition of bacteria in the gut,” says Dr. Ausk.

In fact, antibiotics are often one of the first Crohn’s treatments that doctors will try. The most commonly used antibiotics for Crohn’s disease are Flagyl (metronidazole) and Cipro (ciprofloxacin).

“When patients enter with mild Crohn’s, we often treat them first with antibiotics and see how they do it,” says Ausk. If antibiotics do not work, the next step will probably be other Crohn’s medicines, such as steroids or biological products.

How Antibiotics Work in Crohn’s Disease

The goal of antibiotics in Crohn’s disease is similar to the goal of other Crohn’s drugs and treatments: to put it in remission and to improve symptoms, says Andrew Forest, a specialist in clinical pharmacy at the University of Maryland Medical Center in Baltimore.

Antibiotics work to achieve remission in different ways. “Crohn’s antibiotics can treat the actual course of the disease – progressive inflammation – as well as complications such as abscesses and wound infections,” says Randall Meisner, MD, gastroenterologist at Spectrum Health Medical Group in Grand Rapids, Mich.

Dr. Meisner says that antibiotics for Crohn’s disease can work as follows:

  • Decreasing concentrations of bacteria and fungi in the intestine
  • Alter the composition of bacteria in the intestine to remove bad bacteria and promote good bacteria
  • Decrease bacterial invasion, thus avoiding abscesses

Research supports this. “In a study using the antibiotic metronidazole, bacteria were eliminated and patients experienced remission for six months,” Forest says. He adds that the antibiotic ciprofloxacin appears to improve Crohn’s symptoms by eliminating bacteria, notably E. coli.

Safe use of antibiotics in Crohn’s disease

The amount of time you should take antibiotics for Crohn’s depends on your comfort level and your doctor. “Studies on the use of antibiotics in Crohn’s disease range from six weeks to six months,” says Meisner.

In general, the forest says that the longer Crohn is treated with antibiotics, the worse the antibiotic side effects are.

Side effects of metronidazole include nausea, vomiting, loss of appetite, diarrhea, dizziness, metallic taste and dark urine or reddish brown. When taken long-term, metronidazole may also cause tingling of the hands and feet. Side effects of ciprofloxacin include headaches, nausea, vomiting, abdominal pain, rash and restlessness. And both antibiotics can promote bad bacteria and infections like Clostridium difficile, Meisner adds.

“Overall, the most important thing I can say to people taking antibiotics for Crohn’s disease is to take the prescribed drugs and make sure to inform their providers of any adverse effects they experience,” Forest says. Also be sure to ask your doctor about possible interactions with other medications you are taking.

Probiotics: an option similar to antibiotics

As an alternative to antibiotics, probiotics – microorganisms derived from food sources such as dairy products grown as yogurt – are also potential Crohn’s treatments. They work similarly to antibiotics by altering the balance of good and bad bacteria in the gut. Probiotics are relatively safe and carry few side effects, so you probably can not harm adding yogurt to your daily diet. However, a review of the few small probiotic studies for Crohn’s are inconclusive, according to research published in the Cochrane Database of Systematic Reviews.

“There is some evidence that probiotics may work in inflammatory bowel disease, but at this point, there is more evidence of probiotics in ulcerative colitis than in Crohn’s,” says Ausk. More research is needed before probiotics become a mainstay for Crohn’s treatments.