Use Ciprofloxacin with Adalimumab for Perianal Crohn Disease

Antibiotics, such as metronidazole and ciprofloxacin, and anti–tumor necrosis factor (anti-TNF) agents are effective in treatment of perianal fistulas in Crohn disease. Although patients are often treated with both, the efficacy of this combination therapy is uncertain.

In the current controlled trial from eight hospitals in the Netherlands, 76 patients (mean age, 36) with Crohn disease–related, active perianal fistulas were randomized to receive adalimumab loading doses, followed by 40 mg every other week for 24 weeks, plus either 500 mg of ciprofloxacin or placebo twice daily for 12 weeks. The primary endpoint was closure of ≥50% of draining fistulas.

Thirty-four percent of patients had been treated previously with infliximab. The mean numb…