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Posts Tagged ‘Antibiotics’
What is Colitis
Colitis is a general term for a large number of causes that result in inflammation in the lining of the bowel. Common symptoms associated with colitis are abdominal cramping, frequent loose stools or persistent diarrhea, loss of control of bowel function, fever, sleepiness, and weight loss.
Depending on the cause, colitis may be treated in several ways.One of the first steps in diagnosing colitis is identifying the cause. Some forms of colitis may be caused by infection through bacteria, certain viruses, and some parasites.
For example, exposure to the salmonella bacteria or any other bacteria needs to be treated with antibiotics to resolve the condition. Parasitic or amoebic infection usually warrants a course of either antibiotics or anti-parasitic medication. Viral colitis can be more difficult to treat.
Viruses like Rotavirus or Norovirus can result in dehydration, particularly in the very young or very old. Rest and increased fluid intake are often prescribed. However, if a person becomes severely dehydrated, he or she may need care in a hospital to receive intravenous fluids.
Certain diseases can predispose one to attacks of colitis. The most frequent cause of colitis in those with intestinal diseases is Crohn’s disease, which is a degenerative intestinal disorder. People with Crohn’s are more prone to colitis and to other serious conditions like perforated bowel.
Those with Crohn’s need to take seriously the symptoms listed above and see a doctor immediately. Any of these symptoms can necessitate medical treatment.Irritable bowel disorder (IB) can also cause bouts of colitis.
Since IB is both difficult to diagnose and to treat, anyone who has had frequent recurrences of the symptoms above is prone to colitis and should contact a doctor if he or she suspects colitis. Especially if bacteria or parasites causes the colitis, this can only worsen IB and needs immediate treatment.
While antibiotics are used to treat bacterial colitis, they can also be indicated as a cause of colitis in some cases. Additional causes of colitis may include taking birth control medication, having autoimmune disorders, or smoking.
If diarrhea and fever persist for more than two days, and you don’t have a disease that would necessitate earlier treatment, you should see a doctor quickly. If you have severe stomach pain with fever, you should not wait to see a physician during office hours but proceed to the emergency room, as this may indicate appendicitis or bowel injury.
If you suspect food poisoning, it is better to go the emergency room, since some bacteria can be very harmful.You can reduce your risk of colitis by using sanitary cooking and eating practices, avoiding caffeinated beverages, and not taking medications like ibuprofen if you have irritable bowel or inflammatory bowel conditions.
Treatment for those with frequent bouts of colitis will focus on trying to reduce symptoms such as diarrhea and stomach cramping. Sometimes these treatments of symptoms are the only way to address colitis.
Yet even with treatment, those with Crohn’s and other autoimmune or known stomach disorders should be vigilant if they suspect colitis, since other more serious conditions may also have the same symptoms as colitis.
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Fistulizing Crohns Disease
Fistulas are common in Crohns disease. A population-based study has shown a cumulative risk of 33% after 10 years and 50% after 20 years. Perianal fistulas were the most common (54%). Medical therapy is the main option for perianal fistula once abscesses, if present, have been drained, and should include antibiotics (both ciprofloxacin and metronidazole) and immunomodulators.
Infliximab should be reserved for refractory patients. Surgery is often necessary for internal fistulas. The appropriate treatment of patients with fistulas in the setting of Crohns disease requires a knowledge of the specific medical and surgical literature of fistulizing Crohn’s. The patient with symptomatic fistulizing Crohns disease may respond differently to specific medical therapy than a patient with symptomatic obstructing Crohns disease.
Certain medications that are useful for the treatment of patients with obstructive Crohns disease may not be helpful in the treatment of fistulas in patients with fistulizing Crohns disease (e.g., corticosteroids and mesalamine); in fact, some medications are believed to be detrimental (e.g., corticosteroids). Few studies have been performed to assess the efficacy of specific medications on fistulas directly.
To date, there has been only one published prospective randomized controlled trial that was designed to assess the efficacy and safety of a specific medication on fistulas in patients with Crohns disease; it showed clinical efficacy over placebo in a statistically significant manner. The judicious use of surgery remains an integral part of the management of certain presentations of fistulizing Crohns disease, and the appropriate integration of surgical and medical therapy is of paramount importance in the management of these patients.
This review provides an overview of pertinent medical and surgical literature as it pertains to management of patients with fistulizing Crohns disease. Remicade was also shown to be effective in reducing the number of open, draining fistulas, a painful complication of Crohns disease in which deep openings burrow from the bowel wall through the surface of the skin, causing drainage of mucous and/or fecal material. Remicade is the first product documented to reduce the number of open fistulas in a controlled clinical trial.
In a clinical study of 94 patients with fistulizing Crohns disease (42 patients had single fistula and 52 patients had multiple fistulas), 68 percent of those treated at the recommended dose of Remicade experienced closure of at least 50 percent of fistula(s) for four weeks or more compared with 26 percent of placebo-treated patients. More than one-half (55 percent) of patients with single or multiple fistula(s) treated with Remicade experienced a clinical effect demonstrated clinical response to treatment with Remicade developed an abscess in the area of the fistula between eight and 16 weeks after the last infusion.
“Remicade represents a significant advance in the treatment of Crohns disease,” said Stephen Hanauer, M.D., University of Chicago Medical Center, department of gastroenterology, and a principal investigator in the clinical trials. “These patients suffer terribly and we physicians now have an important option available to treat them.”
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Crohns Disease Medication
Treatment for Crohns disease depends on its location and severity, the presence of complications and the patient’s response to medications. The goal of treatment is to reduce the inflammation that triggers symptoms. Treatment relieves symptoms and results in long-term remission.
Treatment for Crohns disease usually involves medication and/or surgery.Drug therapies must be custom-designed for each patient. Finding which medications best alleviate the symptoms may take time. When a patient with Crohns disease undergoes surgery, it is important that the health care team (including the surgeon, anesthesiologist, and the primary treating physician) know which medications the patient is taking. Many patients with mild to moderate disease are treated with medications containing mesalamine.
These medications differ based on what parts of the bowel are treated. The use of mesalamine to treat Crohns disease, either to achieve or maintain remission, is sometimes controversial because not all studies have consistently shown that mesalamine is effective for Crohns disease. Mesalamine is usually well-tolerated and has no serious side effects. Patients may experience nausea, headache and diarrhea.
Some patients who have severe active disease or do not respond to mesalamine therapy may need corticosteroids such as prednisone to control inflammation and induce remission. These drugs are effective but have significant side effects, such as increased susceptibility to infection, mood swings, anxiety, depression, elevated blood pressure, glaucoma, cataracts and osteoporosis.
Physicians may use different strategies to administer these drugs in order to reduce side effects. Budesonide is a corticosteroid that is rapidly broken down by the liver, resulting in a much lower frequency of side effects. These medications are gradually reduced once remission is achieved — and mesalamine or a drug that suppresses the immune system is used to maintain remission.Antibiotics such as metronidazole are sometimes used to treat Crohns disease.
They are particularly helpful in patients with fistulas and are often combined with other medications. The use of metronidazole to treat active Crohns disease or to delay the recurrence of Crohn’s for the first two to three years after an ileum resection surgery is often controversial because not all studies have consistently shown that metronidazole and other antibiotics are effective in these patient groups.
Metronidazole can be effective in managing perineal Crohns disease (involving the pelvic area). Many patients require surgery because medical therapy does not control their symptoms or because complications such as blockage, abscess, perforation or bleeding into the intestines have developed
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Alternative Crohns Disease Treatment
The main treatment for Crohns disease is medicine to stop the inflammation in the intestine and medicine to prevent flare-ups and keep you in remission. A few people have severe, persistent symptoms or complications that may require a stronger medicine, a combination of medicines, or surgery.
The type of symptoms you have and how bad they are will determine the treatment you need. Aminosalicylates (such as sulfasalazine or mesalamine). These medicines help manage symptoms for many people who have Crohns disease. Antibiotics such as ciprofloxacin and metronidazole may be tried if aminosalicylates are not helping your symptoms. These medicines work especially well for disease in the colon.
Antibiotics are also used to treat fistulas, which are abnormal connections or openings between two organs or parts of the body. But 50% of fistulas come back when antibiotics are stopped. Corticosteroids (such as budesonide or prednisone) may be given by mouth for a few weeks or months to control inflammation. But corticosteroids have serious side effects, such as high blood pressure, osteoporosis, and increased risk of infection. Budesonide causes remission in mild or moderate Crohns disease of the ileum and the right colon. It does not work as well as prednisone or other corticosteroids. But it also does not have as many side effects as other corticosteroids. The long-term side effects are not well known, so your doctor will probably not have you take it for a long time.
Prednisone may help if budesonide does not. Medicines that suppress the immune system (called immunomodulator medicines), such as azathioprine (AZA), 6-mercaptopurine (6-MP), or methotrexate. You may take these if the medicines listed above do not work, if your symptoms come back when you stop taking corticosteroids, or if your symptoms come back often, even with treatment.
If you have tried all the medicines listed above and none of them have worked, your doctor may give you a tumor necrosis factor (TNF) antagonist such as infliximab (Remicade). This drug may work for people who have not had any success with other medicines for Crohns disease. Infliximab is also used to treat fistulas if antibiotics do not heal them. Another TNF antagonist that may be used to treat Crohns disease is adalimumab (Humira). It may work for people for whom infliximab has stopped working and for people who have a bad reaction to infliximab.
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