Crohn's Disease Forum » Parents of Kids with IBD » 66% pediatric remission with Azithromycin plus Metronidazole


09-15-2018, 03:02 PM   #1
Pangolin
 
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66% pediatric remission with Azithromycin plus Metronidazole

https://academic.oup.com/ecco-jcc/ar...5/3/222/468526

Results: Thirty two patients (mean age 13.1 ± 3.9, mean duration of disease 0.65 years) were included, of whom 21 (66%) entered clinical remission (PCDAI < 10) after 8 weeks of treatment. The mean age at treatment and duration of disease did not differ between patients entering remission and those unresponsive to therapy. CRP, normalized in 54% of patients with elevated CRP at baseline. Factors associated with lack of response were a more severe disease (reflected by higher PCDAI and CRP values at baseline), presence of arthritis and extensive disease (ileocolonic, or prominent upper intestinal disease).

Conclusions: An 8 week course of azithromycin and metronidazole therapy may be effective in inducing clinical remission in mild-moderate luminal CD in children and young adults.
09-15-2018, 03:03 PM   #2
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Follow up study from 2018 showing similar results: https://gut.bmj.com/content/early/20...-315199.alerts
09-15-2018, 09:08 PM   #3
Lady Organic
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Thats quite interesting, thank you. I think I tried a course of Metronidazole in my early years, but that was a failure. I need to check my medical files.
I'd be interested to try the combo with Azithromycin.
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''UC-like Crohn's'' (2001)
wrists + ankles arthropathies (2013)
on: 50mg 6-MP (Purinethol)+ B12 shots


Diet: ''IBD-AID'' : http://www.nutritionj.com/content/13/1/5+ organic food only
suppl Curcuminoid extract, Inulin,psyllium, apple pectin, Vitamin D

past meds:
pred 50mg, 5-ASA (pill, rectal), cortifoam, Imuran, Purinethol, methotrexate.
09-17-2018, 05:33 PM   #4
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My son has been on this for over a week now, and it seems to be going well. Can't say for sure whether it's helping yet since he was put on it due to signs of inflammation in the blood work rather than much in the way of symptoms, but I think it may be subtly making a difference.

EEN has vastly improved his condition, and this might just knock out the remaining inflammation. He's also on infliximab, but it's less clear how much that's helping.
09-17-2018, 07:17 PM   #5
my little penguin
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How long has he been on remicade ?
That takes 6 weeks in some to 6 months in others
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09-17-2018, 07:40 PM   #6
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He's been on remicade for about 10 months now. I can't really say how much it helped early on, but probably somewhat. However, he got noticeably worse around Feb to April before we started EEN. I don't know whether that means he just needed more remicade (the timing has also been reduced to every 6 weeks, and he's always had 10 mg/kg) or whether it means he needs something else instead/in addition. Since then there's definitely been a huge improvement in symptoms and in the blood work, but right now we're adding these antibiotics due to an ESR that's been staying around 20 for the last few measurements despite the EEN and the shortened remicade timing.
09-17-2018, 09:12 PM   #7
my little penguin
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Be aware that long term use of daily abx
Puts you at greater risk of infection
And likelihood the abx won’t work when you need it too later

FWIW Ds takes Erythromycin daily to improve gastric emptying
Basically so he can eat solid food
GI does not use azythromycin since they want that to be saved for infections


Remicade also increases infection risk

Is there a reason you didn’t just add mtx to boost the Remicade ?
A lot have used that plus een

Good luck
09-17-2018, 09:14 PM   #8
my little penguin
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One other thing
My kiddo had a higher ear last year
Probably had nothing to do with Crohns
Given his Jia was flaring

My point a lot of GI won’t treat the “number”
But combo of number PLUS symptoms /tests
When was his last scope /imaging ?
09-17-2018, 11:01 PM   #9
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The plan is just for 8 weeks, so hopefully we won't run into any long-term problems.

Methotrexate has some potential cognitive effects as an anti-folate that we'd prefer to avoid, and we're a little reluctant about adding even more immune suppression when remicade already increases infection risk.

It is possible that the ESR may not be from the Crohn's. We've noticed that on remicade he's almost constantly sniffly plus clearing his throat more than usual. Probably colds are just lingering for a long time. Not sure if that might affect the ESR. And of course other unknown inflammation elsewhere could also affect the ESR.

However, I think it's most likely that this continuing elevation of ESR really is from the Crohn's. His hematocrit is a bit low at 38. His MCV is a bit high at 90. His ferritin is a bit low at 21. This would seem to go along with some Crohn's inflammation still. His symptoms haven't been zero, just hard to see.

He had a perianal abscess at diagnosis along with abdominal pain and some diarrhea. By December/Jan everything was much better (after antibiotics, supplemental tube feeding, and remicade), but by Feb/Mar/Apr with no tube and no antibiotics things turned around somewhat for the worse. We could see the inflammation around his anus. EEN dramatically turned all that around again, and the perianal region looks normal or very close to normal currently. The abdominal pain is rare now as well (less than once a week). As for current signs, well, there's been a faint bit of blood on his poop/wipe for a while now. Hard to see, but I think it might have improved over the last week.

As for imaging, I am really curious how things are looking right now. He had an MRE in early March, which found some thickening of the terminal ileum. The doctor was quite pleased that it was better than expected at that time. I'm not sure how things are right now, but I would expect that there's been a lot of healing in most places there. I assume that imaging will be on the agenda pretty soon.
09-17-2018, 11:30 PM   #10
Maya142
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EEN is supposed to help with mucosal healing, so hopefully the scope will show healing.

I just wanted to comment on the persistently elevated ESR. My kiddo has a persistently high CRP. We initially tried to explain it away by saying it was a virus but either she's had a virus for two years or it's something inflammatory .

And considering she has constant pain in MANY joints and we still see swelling, we are pretty sure it is her arthritis.

While a one-time elevated marker is not a big deal, if it keeps being elevated, there is a problem.

The specialists we have talked to, including two researchers, were concerned about the high inflammatory marker, especially given how much medication she is on (she is on 2 biologics and an immunomodulator). I pointed out that while her SI joint MRI still showed inflammation, it wasn't a lot of inflammation compared to past MRIs and there hadn't been too much progression in the last 2 years. They said that was good, but it did not negate the fact that there was clearly still a lot of inflammation in her body .

Most studies do show a high CRP at least is correlated with worse disease in AS. A high CRP is also associated with heart disease down the line, which she is at higher risk for anyway because of the AS.

The bottom line is that while a low CRP/ESR does not rule out disease (which is why blood work is usually paired with a Fecal Calprotectin or imaging when you're trying to figure out if there is inflammation), a high CRP is very likely inflammation and very likely not good news. If you need more information, such as where the disease is active, imaging is necessary.

For what it is worth, my older daughter has been on MTX for 9 years or so and she has had no cognitive side effects. My younger daughter was on and off it for 3 years. Most kids tolerate it very well - you only tend to hear the horror stories but kids mostly have mild side effects.

Additionally, they have both been to middle, high school and college on biologics + immunomodulators. They have had no trouble with biologics or MTX. My daughter did have an increase in infections with Imuran and was taken off it.

But biologics have been fine - my daughter's rheumatologist used experimental "high dose Remicade" for her arthritis - 20 mg/kg every 4 weeks. I was so worried but she was absolutely fine!
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Mom of M (20)
diagnosed with Crohn's Disease at 16
Juvenile Idiopathic Arthritis at 12
Juvenile Ankylosing Spondylitis at 16

Mom of S (23)
dx with JIA at 14
Ankylosing Spondylitis at 18
09-17-2018, 11:34 PM   #11
Maya142
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I wanted to add - my daughters has had CDiff twice, which she got from antibiotics. Azithromycin was not the antibiotic that caused CDiff - Ceftin and Cipro did. Cipro is used for Crohn's sometimes, often in combination with Flagyl. I was shocked to find out it can cause CDiff., as can Flagyl (ironically, Flagyl is also used to treat CDiff!).

CDiff was absolutely miserable and the hospital tried to admit my daughter twice (but she was over 18 and decided she wanted to be home . We had to go the ER twice just for fluids.

So I would be very wary of all antibiotics. Remember that CDiff can cause a flare which could lead to even more issues.
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