Ulcerative colitis: no clear role for metronidazole in acute severe disease.

Clinical bottom line (level 1b-)

  1. Metronidazole had no clear effect on improving signs and symptoms in patients with severe acute ulcerative colitis.
Chapman et al: Gut 1986; 27: 1210-1212
Expires Unknown Month 2001

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: university hospital, UK

39 patients (aged range 16 to 85 years; mean 43, 51% female) with acute severe ulcerative colitis (diagnosed by sigmoidoscopy and rectal histology; based on Truelove and Witts criteria)
Control Group: (n = 20, 20 analysed): placebo
Experimental Group: (n = 19, 19 analysed): intravenous metronidazole 500 mg twice daily for five days
All patients were nil by mouth and had 16 mg methylprednisolone every six hours po, 100 mg hydrocortisone enema twice daily and parenteral nutrition. Patients had blood transfusions if haemoglobin was < 10 g/dl.
100% followed for 5 days
Outcome notes:
  • no change or worse : improvement: passage of three or more formed or forming stools daily, absence of rectal bleeding, and absence of clinical signs of severity (e.g. pyrexia and/or tachycardia)

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
no change or worse 5 days 6
(30.0%)		 5
(26.3%)		 12%
(-140% to 68%)		 3.68%
(-24.5% to 31.9%)		 27
(NNT = 3 to infinity;
NNH = 4 to infinity)

Comments

  1. The study is too small to show any clear benefit from giving metronidazole.

Citation

  1. Chapman RW, Selby WS, Jewell DP: Controlled trial of intravenous metronidazole as an adjunct to corticosteroids in severe ulcerative colitis. Gut 1986; 27: 1210-1212
Search Terms: Crohn* in Cochrane
Contributor: Chris Ball and Clare Wotton, Unknown Month 2000
Reviewer:

Clinical Question.
Patient severe acute ulcerative colitis
Intervention or Exposure metronidazole
Comparison placebo
Outcome improvement