Benefit has been demonstrated, however, with 3-g doses in reducing endoscopic and clinical evidence of disease process in postoperative recurrence studies. Metronidazole is the most commonly used antibiotic and its efficacy is comparable to sulfasalazine. Metronidazole has been effective in treatment of perianal disease and has transiently reduced recurrence of the disease process after ileal resection. Ciprofloxacin has been as effective as mesalamine in mild to moderate Crohn s disease and has been used in combination with metronidazole for ileal and perianal disease. Studies of combination therapies with antimycobacterial therapies in Crohn s disease have been inconsistent in terms of their effectiveness for active disease and maintenance of remission.
Corticosteroids are an integral part of therapy for moderate to severe Crohn s disease.
Significant benefit was noted in a large controlled study in steroid-treated patients for all disease locations. This is usually accomplished with a dual-photon bone density scan. If there is evidence of osteopenia or osteoporosis, therapy with a bisphosphonate or calcitonin is indicated. Weight-bearing exercise, supplemental calcium, and vitamin D are also used, but care must be taken if there is a history of nephrolithiasis. Low-dose budesonide has not yet been proven efficacious for the prevention of relapse.