Posts Tagged ‘Fistula

Overall (Table 1), metronidazole and cyclosporine have a high efficacy in closing or improving fistulas, with an onset of action of a few days to a few weeks. However, neither drug provides sustained healing of fistulas, and both are rather poorly tolerated. Thalidomide shows promise in inducing closure or improvement of fistulas within weeks, but the […]

Metronidazole in a dose of 20 mg/kg, or 1000 to 1500 mg/day has been studied in three uncontrolled trials. Closure of fistulas occurred in 37%, 38% and 56% of patients, and improvement occurred in 63%, 62% and 28% of the 18, 26 and eight enrolled patients, respectively. Time to response varied from one to two […]

An ideal drug in the management of IBD fistula would treat the disease as well as the fistula; have a rapid onset of action; induce long term remission; be safe, easy to administrate and monitor; and be cost effective. No single drug can achieve all of these goals. The best management strategy is to induce […]

In a trial using infliximab for the treatment of fistulas, side effects occurring more frequently with the active treatment than with the placebo were abscesses (11%), upper respiratory tract infections (10%) and fatigue (10%). One of the 63 (1.6%) patients treated with infliximab discontinued therapy because of pneumonia. Concerns about infliximab relate to the development […]

In a trial using thalidomide 200 to 300 mg/day, sedation was reported to some extent by all patients, often requiring a reduction in the dose. Overall, three of the 22 patients (14%) discontinued the drug because of adverse events. The safety profile improved in a trial using a lower dose (50 to 100 mg/day); the […]

In general, all drugs can be used safely by physicians who have experience with specific therapeutic modalities. Nevertheless, adverse events are common with all drugs and may lead to withdrawal of therapy. Metronidazole, when used for several months at high doses, has been associated with side effects in almost all patients; these side effects often […]

INFLIXIMAB Infliximab, a humanized chimeric monoclonal antibody to tumour necrosis factor-alpha, was recently assessed in a randomized, double-blind, placebo controlled study involving 94 patients with fistulas. After a median response time of two weeks, fistulas closed in 46% (29 of 63) and 13% (four of 31) of infliximab-treated and placebo-treated patients, respectively; improvement was also […]

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