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Drugs Used To Treat IBD in Children

Many Medications Used To Treat Adult IBD Are Also Used For Children With IBD

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Updated June 04, 2014

Crohn's disease and ulcerative colitis are generally thought of as young people's diseases. Many with inflammatory bowel disease (IBD) are diagnosed between the ages of 15 and 25.

Drugs are typically tested and approved for use in adult patients. This often means that treatment regimens for children and teens are determined from the results of studies done on adults. Treating children with the same medications as adults can be challenging. Increasingly, treatments are being studied on children as well as adults, particularly for diseases such as IBD that are found often in younger people.

Aminosalicylates

The 5-aminosalicylate (5-ASA) drugs are used frequently to treat kids with IBD. They are most often used for mild or moderate cases of ulcerative colitis or Crohn's colitis. These drugs are used for maintenance purposes and, when taken long-term, can help in maintaining remission. The older drug in this class, sulfasalazine (Azulfadine), has a long history of safe and effective use in adults. Sulfasalazine is a combination of two drugs (sulfapyridine and 5-ASA, an aspirin-like compound) that reduce inflammation in the colon and help maintain remission. Side effects can include headache, sensitivity to sunlight, nausea, diarrhea, and abdominal pain.

The newer drugs in this class, mesalamine (Asacol, Pentasa) and olsalazine, tend to have fewer side effects than sulfasalazine. These formulations do not contain sulfa. Instead, the active ingredient (5-ASA) is enclosed in a coating that keeps it intact until it reaches the colon. This results in more of the drug being released into the area where it is needed (the intestine). Common side effects include headache, abdominal pain, and diarrhea.

The 5-ASA drugs come in several forms. They may be taken orally or rectally. These medications may need to be taken in three or four doses throughout the day. Younger patients may have trouble working their drug schedule into their daily school routine or in remembering to take their medication so many times each day. Oral solutions of these drugs are not readily available.

Steroids

Corticosteroids may be prescribed for an active flare-up of IBD. They may be given intravenously, orally, or topically. How the drug is given depends largely upon the location of the active disease, but also upon the severity of the symptoms. Corticosteroids are for acute disease and are used for as short a time as possible, so they are often given along with another medication such as a 5-ASA drug. Both oral and intravenous steroids have a significant potential for side effects, so the dosage is tapered as soon as possible until the drug is discontinued.

Oral corticosteroids are used for mild-to-moderate disease, with dosages for children calculated based on their weight in kilograms. Steroids given intravenously in a hospital setting are tapered down to a level that can be given orally as soon as possible. Topical steroids are used primarily when the location of the active disease is near the end of the colon and in the rectum. They may be given as an enema or as a foam that is held in the rectum.

Side effects are common with the oral and intravenous forms of corticosteroids, and less common with the enema and foam formulations. Most side effects will decrease when the drug is tapered down and discontinued, but some adverse effects are permanent. Common side effects that may be especially troubling to children and adolescents include acne, facial hair growth, weight gain, and rounding of the face. Corticosteroids are also associated with reduced bone mass and delayed development and growth in children. Corticosteroids do not make children more prone to catching colds or the flu, but children taking corticosteroids are more susceptible to becoming infected with chickenpox (varicella) and other forms of the herpes virus.

Antibiotics

Metronidazole (Flagyl) and ciprofloxacin (Cipro) are two antibiotic drugs that may be used to treat IBD in children. Antibiotics may be used for more mild cases of IBD and are often used in conjunction with other medications, such as the 5-ASA drugs. Metronidazole may be used in particular for perianal Crohn's disease (disease that is located in the anus, rectum, and vaginal areas) or in patients with Crohn's disease complicated by perianal fistulas. Ciprofloxacin may be used as an alternative to metronidazole in perianal Crohn's disease, and it also may be used to treat milder cases of left-sided ulcerative colitis.

Side effects of metronidazole include diarrhea, vomiting, and numbness in the hands and feet which may be from reversible nerve damage (peripheral neuropathy). Metronidazole should not be taken with alcoholic drinks, as it can cause severe nausea and vomiting. Ciprofloxacin is associated with side effects such as nausea, vomiting, diarrhea, and headache.

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