Antibiotics for Crohn’s Disease: What You Should Know

The first question you may be thinking: Do antibiotics increase our chances of heading into flare-up city?

Chances are, we’ve all been prescribed a dose of antibiotics at least once in our life, whether for a medical problem related to inflammatory bowel disease (IBD) or something else. Some of us may even be taking antibiotics more regularly.

In 2020, healthcare professionals prescribed nearly 202 million antibiotic prescriptions, according to The Centers for Disease Control and Prevention (CDC). There’s no denying that antibiotics are extremely useful for a whole range of infections — in fact, they can even be lifesaving.

But when it comes to those of us with Crohn’s disease, we need to understand a little more about this type of medication.

How can we ensure the ones we take are compatible with our condition? Should we worry about them causing a flare-up? What questions should we ask our doctor when it comes to antibiotics and IBD? Let’s find out.

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Can antibiotics cause Crohn’s disease flare-ups?

The first question you may be thinking: Do antibiotics increase our chances of heading into flare-up city?

We all know that, when fighting the bad bacteria in our bodies (such as the ones that are responsible for an ear infection or a painful urinary tract infection), antibiotics may also disrupt the balance of good bacteria in our gut.

This is common and usually short-lived, but as we learn more about our microbiome, it’s worth considering the role antibiotics play.

In a 2020 study, researchers found that greater antibiotic use is linked to an increased risk of developing ulcerative colitis and Crohn’s disease. It’s important to stress that this isn’t a certainty, and more research is necessary.

In my case, though, it rings true. I remember constantly being on and off antibiotics as a child due to repeated ear infections, and I do wonder if that may have played a part. However, this is just one element of our gut microbiome and there are many other factors at play.

It’s actually not all bad news for those of us who’ve already been diagnosed with Crohn’s disease. In some cases, a doctor may prescribe antibiotics to help treat IBD.

A 2016 study suggested antibiotics can actually lead to less disease activity and even remission for people with Crohn’s disease, though more research is needed.

Why do people with IBD take antibiotics?

There are many reasons why someone with IBD might take antibiotics. First, infections can be common for those diagnosed with perianal disease, which manifests as abscesses and fistulas.

I’ve had repeated abscesses, and antibiotics are usually the first-line defense at trying to prevent infections from spreading further. In some cases, antibiotics can even stop an abscess from getting to the stage where surgical intervention is required.

It’s also common for infections to happen after abscess drainage and fistulotomy, so I’ve been prescribed antibiotics as a preventive treatment, too.

Given that many of us with IBD also take immunosuppressant medication, we know that we’re at a higher risk of getting general infections, since our immune system is often lowered. So, antibiotics might be prescribed in these cases to ensure an infection doesn’t escalate.

I’ve been lucky that I haven’t had many infections since being on Humira over the past few years, but it really is different for everybody.

One common complication of IBD is small intestine bacterial overgrowth (SIBO), which occurs when bacteria rapidly multiply in the small intestine. SIBO can cause symptoms, such as persistent diarrhea, bloating, and stomach pain.

People with Crohn’s disease are at a higher risk of developing SIBO, and treatment with antibiotics can typically resolve symptoms.

Can antibiotics treat IBD?

Sometimes antibiotics are given to treat Crohn’s disease itself. This isn’t common practice, and it’s not something I’ve tried, but research is underway.

One type of treatment that researchers are investigating is known as anti-MAP therapy. It involves a triple strain of antibiotics. The theory behind this treatment is that a strain of bacteria known as Mycobacterium avium subspecies paratuberculosis (shortened to MAP) is responsible for Crohn’s disease. More research is needed to determine how the bacteria plays a role in IBD.

Are there any Crohn’s-compatible antibiotics?

Most antibiotics are fine to take with IBD. The most common ones that healthcare professionals prescribe include metronidazole and ciprofloxacin.

However, it’s common for antibiotics to cause temporary diarrhea in general. I almost always experience antibiotic-associated diarrhea, and it’s really not ideal for those with Crohn’s disease.

This depends on the type of antibiotic though, so once you find one that works for you, you may be advised to try it again. You’re usually encouraged to persist with the antibiotics unless the side effects are very bad.

Alternatively, your doctor may advise you to not take an antibiotic on an empty stomach or prescribe you an antibiotic that’s less likely to cause diarrhea.

Sometimes, those with Crohn’s disease are given antibiotics as a “just in case” scenario, because doctors are concerned that a potential infection could worsen. While this is a valid idea, balance is important: Studies in the United States have found that 30 percent of antibiotics prescribed aren’t actually necessary.

There’s also a downside to recurrent antibiotics for IBD. Studies suggest long-term use can lead to antibiotic resistance and Clostridium dificile infection. It’s worth speaking with your doctor if you’re regularly advised to take antibiotics.

The bottom line

While antibiotics can’t cure Crohn’s disease and aren’t a typical treatment for it, they’re a useful type of medication to prevent infections or help with abscesses and fistulas that come with perianal disease.

It’s always worth keeping a log of antibiotics you’re prescribed and any potential side effects, as well as chatting with your doctor about your antibiotic use if it concerns you.