Infliximab Metronidazole

In the majority of patients, active Crohn s disease is treated with sulfasalazine, mesalamine derivatives, or steroids, although azathioprine, mercap-topurine, methotrexate, infliximab, and metronidazole are frequently used. 

The present primary mode of therapy for these diseases involves the use 5-amino-salicylate (5-ASA) products. Often patients require additional medications, including corticosteroids, to help induce remission and various immune modulators, such as azathioprine, 6-mercaptopurine or methotrexate, to maintain remission. In Crohn s disease certain antibiotics, such as metronidazole and ciprofloxacin, and infliximab Remi-cade), an anti-tumor necrosis factor-a(TNFa) antibody, also have been used. The pharmacology of antibiotics, immunosuppressive drugs, and corticosteroids is discussed in Chapters 43,57, and 60, respectively. 

Other drugs that are useful for treatment of Crohn s disease include metronidazole (for perineal disease), azathioprine or mercaptopurine (for inadequate response or to reduce steroid dosage), cyclosporine (for refractory disease), and infliximab for refractory or fistulizing disease. 

Drug intolerance often limits the usefulness of agents used to treat IBD. Many patients receiving sulfasalazine, mesalamine, corticosteroids, metronidazole, azathioprine, mercaptopurine, or infliximab experience some undesired effects. In some cases, these adverse effects can be significant and require discontinuation of the therapy. Knowledge of the common or important adverse reactions will assist in avoiding or minimizing their effects. 

The manufacturers note that serum levels of infliximab appear to be unaffected by baseline use of medications to treat Crohn s disease including aminosalicylates, ciprofloxacin, corticosteroids and metronidazole. ... 

Live vaccines should not be given to patients undergoing treatment with infliximab. Serious infection and neutropenia is predicted to occur if infliximab is given with anakinra. Infliximab may increase serum levels of azathioprine metabolites, and a rare T-cell lymphoma has been reported in adolescents and young adults treated with infliximab and also given azathioprine or mercaptopurine. Serum levels of infliximab appear to be unaffected by aminosalicylates, corticosteroids, ciprofloxacin or metronidazole. 

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See also in sourсe #XX -- [ ]

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