Assuntos
Antifúngicos/uso terapêutico , Terapia Biológica/efeitos adversos , Bolsas Cólicas , Doença de Crohn/cirurgia , Histoplasmose/etiologia , Hospedeiro Imunocomprometido , Pouchite/etiologia , Fístula Retal/etiologia , Superinfecção/microbiologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Corticosteroides/administração & dosagem , Adulto , Antibacterianos/administração & dosagem , Antifúngicos/administração & dosagem , Colectomia , Colite/cirurgia , Bolsas Cólicas/microbiologia , Bolsas Cólicas/patologia , Esquema de Medicação , Feminino , Histoplasmose/tratamento farmacológico , Histoplasmose/microbiologia , Humanos , Ileostomia , Itraconazol/uso terapêutico , Desnutrição/complicações , Pouchite/microbiologia , Pouchite/patologia , Fístula Retal/microbiologia , Fístula Retal/patologia , Superinfecção/tratamento farmacológico , Superinfecção/etiologia , Fatores de Tempo , Falha de Tratamento , Resultado do TratamentoRESUMO
In this study we aimed to determine the microorganisms found in perianal fistulas in Crohn's disease and whether treatment with ciprofloxacin affects these microorganisms. Thirteen patients (males/females, 7/6; median age, 34 years; range, 18-61 years) with fistulas were treated with infliximab, 5 mg/kg intravenously, at weeks 6, 8, and 12 and randomized to double-blind treatment with ciprofloxacin, 500 mg bd (n = 6), or placebo (n = 7) for 12 weeks. Samples were taken at baseline and at weeks 6 and 18. In the ciprofloxacin group 10 different genera of microorganisms were identified, while 13 genera could be identified in the placebo group. Gram-negative enteric floras were present in a small minority. The genera found in patients with perianal fistulas were predominantly gram-positive microorganisms. Therefore, antimicrobial treatment should be directed toward these microorganisms.