Crohn’s Disease: Fistula – alternative approach

Fluoroquinolone are pretty standard for treating fistulas because it is so broad spectrum. Unfortunately, there are significant risks.

Safety Announcement

[8-15-2013]  The U.S. Food and Drug Administration (FDA) has required the drug labels and Medication Guides for all fluoroquinolone antibacterial drugs be updated to better describe the serious side effect of peripheral neuropathy. This serious nerve damage potentially caused by fluoroquinolones (see Table for a list) may occur soon after these drugs are taken and may be permanent.

The risk of peripheral neuropathy occurs only with fluoroquinolones that are taken by mouth or by injection.  Approved fluoroquinolone drugs include levofloxacin (Levaquin), ciprofloxacin (Cipro), moxifloxacin (Avelox), norfloxacin (Noroxin), ofloxacin (Floxin), and gemifloxacin (Factive).  The topical formulations of fluoroquinolones, applied to the ears or eyes, are not known to be associated with this risk.

If a patient develops symptoms of peripheral neuropathy, the fluoroquinolone should be stopped, and the patient should be switched to another, non-fluoroquinolone antibacterial drug, unless the benefit of continued treatment with a fluoroquinolone outweighs the risk. Peripheral neuropathy is a nerve disorder occurring in the arms or legs. Symptoms include pain, burning, tingling, numbness, weakness, or a change in sensation to light touch, pain or temperature, or the sense of body position.  It can occur at any time during treatment with fluoroquinolones and can last for months to years after the drug is stopped or be permanent.  Patients using fluoroquinolones who develop any symptoms of peripheral neuropathy should tell their health care professionals right away.

A Request

A dear friend who had a fistula and developed peripheral neuropathy on the second course (quickly stopping) as me to look for alternatives. The first question was what bacteria are we dealing with – it turns out to be one family, the bacteriodes as cited in the text book below:


With this information, I could search for herbs and spices that were effective. It appears that there is only one herb that has been demonstrated effective (of almost 200 tested), rhubarb root (Rheum officinale)  [Anti-Bacteroides fragilis substance from rhubarb. 1987].

I found another study finding that Swedish Bitters had some effect, but looking at the ingredients, there was rhubarb root, so it’s effectiveness was thus explained.

Looking for herbs effective against peptostreptococcus, I found nothing on PubMed. There are several oral probiotics (intended for the gums in the mouth) that contain streptococcus (see prior post), which could inhibit this growth.

CFS Impact

CFS patients are low in bacteroides and thus you should avoid Swedish Bitters and Rhubarb Root.

However, rhubarb root does work well as a laxative (which may include diarrhea for a day with two 00 pills full of it) and thus may have some benefit in clearing your system for new probiotics.