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
- Refer to CKS and ECCO for further information on the prescribing of aminosalicylates in ulcerative colitis and Crohn’s disease
- NICaN Referral Guidance for Suspected Cancer (Red Flag Criteria)
Fistulating Crohn’s disease
Managing flare-ups in patients who have been diagnosed by a specialist as part of a care plan:
| Choice | Drug | Dosage |
|---|---|---|
| 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 |
| Or | ||
| Ciprofloxacin 500mg tablets, 250mg/5 ml suspension | Dose: 500mg twice daily orally |
Prescribing Notes
- 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.
Caution
- 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.