1.5 Chronic bowel disorders
Chronic bowel diseases include ulcerative colitis and Crohn’s disease. Aminosalicylates, corticosteroids and drugs that affect the immune response form the basis of drug treatment.
The following guidelines apply:
- NICE NG129 covers Crohn’s disease
- NICE NG130 covers Ulcerative Colitis
- Northern Ireland IBD Pathway (under review)
- Refer to CKS and ECCO for further information on the prescribing of aminosalicylates in ulcerative colitis and Crohn’s disease
Fistulating Crohn’s disease
Managing flare-ups in patients who have been diagnosed by a specialist as part of a care plan:
|1st choice||Metronidazole 400mg tablets, 500mg tablets, metronidazole (as benzoate) 200mg/5 ml suspension||Dose: 10-20mg/kg daily orally in divided doses (usual dose 400-500mg three times daily); usually for 1 month but no longer than 3 months because of concerns about peripheral neuropathy|
|Ciprofloxacin 500mg tablets, 250mg/5 ml suspension||Dose: 500mg twice daily orally|
- Patients with flare-ups should generally be referred back to secondary care for assessment.
- Patients who have been diagnosed with fistulating Crohn’s disease by a specialist may sometimes be managed in primary care when they present with flare-ups, provided they have previously responded and this is part of the care plan for the patient.
- Azathioprine is used as a second-line treatment for fistulating Crohn’s disease and continued for maintenance.
- Fluoroquinolone antibiotics – see new MHRA restrictions and precautions for use due to very rare reports of disabling and potentially long lasting or irreversible side effects.