Inflammatory Bowel Disease : Medical Therapy
Medical Treatment for IBD
There are many different approaches for treating pediatric IBD. For most patients, the primary initial treatment involves medications.
There are two primary methods for using medication:
- Induction therapy is used to alleviate the symptoms of an IBD flare-up
- Maintenance therapy is used for long-term management of the disease
Similar medications are used to treat both ulcerative colitis and Crohn’s disease. They include:
Corticosteroids (Prednisone, Prednisolone, Methylprednisolone)
These medications are induction therapies for moderate to severe IBD, and have been used for over 50 years. They are usually used short term (a few weeks to a few months) to get moderate to severe Crohn’s Disease or ulcerative colitis under control.
Aminosalicylates - Sulfasalazine, Olsalazine, Mesalamine, Balsalazide
These are among the safest medications used to treat IBD, but are generally effective only in milder cases. They are most effective as maintenance therapies in mild to moderate ulcerative colitis.
Antibiotics – Metronidazole, Ciprofloxacin–Cipro®
Antibiotics are often used to treat infectious complications of inflammatory bowel disease, such as abscesses in the abdomen or around the anus (perianal). They also may be used to treat mildly active Crohn’s Disease and are sometimes utilized to treat mild flares of ulcerative colitis.
Azathioprine AZA and 6-mercaptopurine (6MP)
These two medications are primarily used as maintenance treatment in Crohns’ disease, and have been used for over 25 years. They are also used in patients with ulcerative colitis whose symptoms persist despite the use of amniosalicylates (see above). These medications typically take 3-6 months to be effective.
Methotrexate is another immunomodulatory medication used as a maintenance therapy for Crohn’s disease. This medicine typically takes 4 weeks before it may be effective.
Infliximab is usually used in patients with Crohn’s disease who have not responded to corticosteroids and immunomodulators. It also may be utilized in patients with ulcerative colitis who have not responded to these medications.
Cyclosporine (Gengraf ®, Neoral ®, Restasis ®, and Sandimmune ®) and Tacrolimus (Prograf ®)
Cyclosporine and tacrolimus are medications that may be used short term to induce a remission in Crohn’s or ulcerative colitis patients with severe symptoms and persistently active disease despite conventional treatments