Metronidazole has been most widely used because studies have shown it to be effective and safe. Side effects include nausea, a metallic taste and peripheral neuropathy characterized as numbness in the hands and feet. These symptoms resolve when the medication is discontinued. Ciprofloxacin has also been shown to be useful but is more expensive than metronidazole. Corticosteroids, such as prednisone or hydrocortisone, are potent immunosuppressive medications which are used to treat inflammation of the entire small and large bowel in moderate to severely active Crohn's disease.
Preparations are available for oral, rectal and intravenous administration.
Corticosteroids work very quickly and are also fairly inexpensive. Unfortunately, they have many undesirable side effects when used long term, which include adrenal gland suppression, hypertension, diabetes, osteoporosis, cataracts and hip fracture. Because of these side effects, the duration of their use should be limited when possible. These medications can maintain Crohn's disease in remission and can be used to treat fistulas associated with Crohn's disease. Methotrexate is another immunosuppressive medication used to treat patients dependent on steroids to control their Crohn's disease.