Intravenous tobramycin and metronidazole as an adjunct to corticosteroids in acute, severe ulcerative colitis.

Abstract

The aim of this study was to evaluate the role of metronidazole and tobramycin as an adjunct to corticosteroids in acute, severe ulcerative colitis. Thirty-nine consecutive patients with severe ulcerative colitis were randomized on admission to the hospital to receive intravenously either metronidazole (0.5g tid) and tobramycin (4 mg/kg tid) (n = 19), or placebo (n = 20). In addition, they were given parenteral nutrition, intravenous hydrocortisone (100 mg qid) and hydrocortisone enemas (100 mg bid). All patients were assessed after 10 days of continuous treatment, or at any time a severe complication occurred. Twelve of 19 patients (63.15%) treated with antibiotics and 13/20 patients (65%) with placebo showed substantial improvement. Seven patients in each group did not improve (n = 9), or developed complications (n = 5) and underwent emergency colectomy without perioperative deaths or late deaths. These results do not support the routine use of intravenous tobramycin and metronidazole in the treatment of severe ulcerative colitis.