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:

Fistulating Crohn’s disease

Managing flare-ups in patients who have been diagnosed by a specialist as part of a care plan:
ChoiceDrugDosage
1st choiceMetronidazole 400mg tablets, 500mg tablets, metronidazole (as benzoate) 200mg/5 ml suspensionDose: 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.