Anal fistula medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Template:Anal fistula}} | {{Template:Anal fistula}} | ||
{{CMG}} {{AE}} {{MKK}} | {{CMG}}, {{AE}}{{MKK}} | ||
==Overview== | ==Overview== | ||
Pharmacotherapy used in | Pharmacotherapy used in anal fistula depends upon the location and symptoms of patient. [[Antibiotics]] are used in patient with comorbities like [[immunosuppression]], [[diabetes]], extensive [[cellulitis]], [[Prosthetic devices|prosthetic]] devices and high risk [[cardiac]] patients. [[Antipyretics]] and [[analgesic]] for symptomatic relief of [[pain]] and [[fever]]. Treatment of underlying causes is important to treat recurrent anal fistulas. | ||
==Pharmocotherapy== | ==Pharmocotherapy== | ||
*Empiric therapy for | *Empiric therapy for anal fistula depends on following factors:<ref name="urlwww.fascrs.org">{{cite web |url=https://www.fascrs.org/sites/default/files/downloads/publication/clinical_practice_guideline_for_the_management_of_anorectal_abscess_fistula-in-ano_and_rectovaginal_fistula.pdf |title=www.fascrs.org |format= |work= |accessdate=}}</ref> | ||
**Location of | **Location of anal fistula. | ||
**If the patient shows signs and symptoms of [[abscess]]. | **If the patient shows signs and symptoms of [[abscess]]. | ||
*Main stay of therapy is surgical management but [[antibiotics]] are given in the following condition:<ref name="pmid15933794">{{cite journal |vauthors=Whiteford MH, Kilkenny J, Hyman N, Buie WD, Cohen J, Orsay C, Dunn G, Perry WB, Ellis CN, Rakinic J, Gregorcyk S, Shellito P, Nelson R, Tjandra JJ, Newstead G |title=Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised) |journal=Dis. Colon Rectum |volume=48 |issue=7 |pages=1337–42 |year=2005 |pmid=15933794 |doi=10.1007/s10350-005-0055-3 |url=}}</ref><ref name="pmid9236458">{{cite journal |vauthors=Dajani AS, Taubert KA, Wilson W, Bolger AF, Bayer A, Ferrieri P, Gewitz MH, Shulman ST, Nouri S, Newburger JW, Hutto C, Pallasch TJ, Gage TW, Levison ME, Peter G, Zuccaro G |title=Prevention of bacterial endocarditis. Recommendations by the American Heart Association |journal=Circulation |volume=96 |issue=1 |pages=358–66 |year=1997 |pmid=9236458 |doi= |url=}}</ref> | *Main stay of therapy is surgical management but [[antibiotics]] are given in the following condition:<ref name="pmid15933794">{{cite journal |vauthors=Whiteford MH, Kilkenny J, Hyman N, Buie WD, Cohen J, Orsay C, Dunn G, Perry WB, Ellis CN, Rakinic J, Gregorcyk S, Shellito P, Nelson R, Tjandra JJ, Newstead G |title=Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised) |journal=Dis. Colon Rectum |volume=48 |issue=7 |pages=1337–42 |year=2005 |pmid=15933794 |doi=10.1007/s10350-005-0055-3 |url=}}</ref><ref name="pmid9236458">{{cite journal |vauthors=Dajani AS, Taubert KA, Wilson W, Bolger AF, Bayer A, Ferrieri P, Gewitz MH, Shulman ST, Nouri S, Newburger JW, Hutto C, Pallasch TJ, Gage TW, Levison ME, Peter G, Zuccaro G |title=Prevention of bacterial endocarditis. Recommendations by the American Heart Association |journal=Circulation |volume=96 |issue=1 |pages=358–66 |year=1997 |pmid=9236458 |doi= |url=}}</ref> | ||
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**[[Antipyretics]] and [[analgesics]] like [[acetaminophen]], and [[Ibuprofen]]. | **[[Antipyretics]] and [[analgesics]] like [[acetaminophen]], and [[Ibuprofen]]. | ||
==Treatment of underlying cause== | ==Treatment of underlying cause== | ||
*Treatment of | *Treatment of anal fistula with [[Crohns disease|Crohn's]] diseases: | ||
**Anti-[[tumour necrosis factor]] | **Anti-[[TNF-α|tumour necrosis factor α]] antibody, [[infliximab]] is the first line of treatment.<ref name="pmid16611273">{{cite journal |vauthors=Sands BE, Blank MA, Diamond RH, Barrett JP, Van Deventer SJ |title=Maintenance infliximab does not result in increased abscess development in fistulizing Crohn's disease: results from the ACCENT II study |journal=Aliment. Pharmacol. Ther. |volume=23 |issue=8 |pages=1127–36 |year=2006 |pmid=16611273 |doi=10.1111/j.1365-2036.2006.02878.x |url=}}</ref><ref name="pmid14985485">{{cite journal |vauthors=Sands BE, Anderson FH, Bernstein CN, Chey WY, Feagan BG, Fedorak RN, Kamm MA, Korzenik JR, Lashner BA, Onken JE, Rachmilewitz D, Rutgeerts P, Wild G, Wolf DC, Marsters PA, Travers SB, Blank MA, van Deventer SJ |title=Infliximab maintenance therapy for fistulizing Crohn's disease |journal=N. Engl. J. Med. |volume=350 |issue=9 |pages=876–85 |year=2004 |pmid=14985485 |doi=10.1056/NEJMoa030815 |url=}}</ref><ref name="pmid19750568">{{cite journal |vauthors=Taxonera C, Schwartz DA, García-Olmo D |title=Emerging treatments for complex perianal fistula in Crohn's disease |journal=World J. Gastroenterol. |volume=15 |issue=34 |pages=4263–72 |year=2009 |pmid=19750568 |pmc=2744181 |doi= |url=}}</ref> | ||
*Treatment of anal fistula with [[ | *Treatment of anal fistula with [[tuberculosis]]:<ref name="pmid18760061">{{cite journal |vauthors=Bokhari I, Shah SS, Inamullah, Mehmood Z, Ali SU, Khan A |title=Tubercular fistula-in-ano |journal=J Coll Physicians Surg Pak |volume=18 |issue=7 |pages=401–3 |year=2008 |pmid=18760061 |doi=06.2008/JCPSP.401403 |url=}}</ref><ref name="pmid19623062">{{cite journal |vauthors=Donoghue HD, Holton J |title=Intestinal tuberculosis |journal=Curr. Opin. Infect. Dis. |volume=22 |issue=5 |pages=490–6 |year=2009 |pmid=19623062 |doi=10.1097/QCO.0b013e3283306712 |url=}}</ref> | ||
**If the patient is having recurrent [[fistula]] and fail to respond to standard therapy then, [[ | **If the patient is having recurrent [[fistula]] and fail to respond to standard therapy then, [[tuberculosis]] should be suspected. | ||
**Anti-[[tuberculous]] drugs are the first line treatment. | **Anti-[[tuberculous]] drugs are the first line treatment. | ||
Latest revision as of 20:46, 13 February 2018
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Anal fistula Microchapters |
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Anal fistula medical therapy On the Web |
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Risk calculators and risk factors for Anal fistula medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
Pharmacotherapy used in anal fistula depends upon the location and symptoms of patient. Antibiotics are used in patient with comorbities like immunosuppression, diabetes, extensive cellulitis, prosthetic devices and high risk cardiac patients. Antipyretics and analgesic for symptomatic relief of pain and fever. Treatment of underlying causes is important to treat recurrent anal fistulas.
Pharmocotherapy
- Empiric therapy for anal fistula depends on following factors:[1]
- Location of anal fistula.
- If the patient shows signs and symptoms of abscess.
- Main stay of therapy is surgical management but antibiotics are given in the following condition:[2][3]
- Immunosuppression
- Diabetes
- Extensive cellulitis
- Prosthetic devices
- High-risk cardiac patient
- Other drugs used for symptomatic relief of anal fistula are:
- Antipyretics and analgesics like acetaminophen, and Ibuprofen.
Treatment of underlying cause
- Treatment of anal fistula with Crohn's diseases:
- Anti-tumour necrosis factor α antibody, infliximab is the first line of treatment.[4][5][6]
- Treatment of anal fistula with tuberculosis:[7][8]
- If the patient is having recurrent fistula and fail to respond to standard therapy then, tuberculosis should be suspected.
- Anti-tuberculous drugs are the first line treatment.
References
- ↑ "www.fascrs.org" (PDF).
- ↑ Whiteford MH, Kilkenny J, Hyman N, Buie WD, Cohen J, Orsay C, Dunn G, Perry WB, Ellis CN, Rakinic J, Gregorcyk S, Shellito P, Nelson R, Tjandra JJ, Newstead G (2005). "Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised)". Dis. Colon Rectum. 48 (7): 1337–42. doi:10.1007/s10350-005-0055-3. PMID 15933794.
- ↑ Dajani AS, Taubert KA, Wilson W, Bolger AF, Bayer A, Ferrieri P, Gewitz MH, Shulman ST, Nouri S, Newburger JW, Hutto C, Pallasch TJ, Gage TW, Levison ME, Peter G, Zuccaro G (1997). "Prevention of bacterial endocarditis. Recommendations by the American Heart Association". Circulation. 96 (1): 358–66. PMID 9236458.
- ↑ Sands BE, Blank MA, Diamond RH, Barrett JP, Van Deventer SJ (2006). "Maintenance infliximab does not result in increased abscess development in fistulizing Crohn's disease: results from the ACCENT II study". Aliment. Pharmacol. Ther. 23 (8): 1127–36. doi:10.1111/j.1365-2036.2006.02878.x. PMID 16611273.
- ↑ Sands BE, Anderson FH, Bernstein CN, Chey WY, Feagan BG, Fedorak RN, Kamm MA, Korzenik JR, Lashner BA, Onken JE, Rachmilewitz D, Rutgeerts P, Wild G, Wolf DC, Marsters PA, Travers SB, Blank MA, van Deventer SJ (2004). "Infliximab maintenance therapy for fistulizing Crohn's disease". N. Engl. J. Med. 350 (9): 876–85. doi:10.1056/NEJMoa030815. PMID 14985485.
- ↑ Taxonera C, Schwartz DA, García-Olmo D (2009). "Emerging treatments for complex perianal fistula in Crohn's disease". World J. Gastroenterol. 15 (34): 4263–72. PMC 2744181. PMID 19750568.
- ↑ Bokhari I, Shah SS, Inamullah, Mehmood Z, Ali SU, Khan A (2008). "Tubercular fistula-in-ano". J Coll Physicians Surg Pak. 18 (7): 401–3. doi:06.2008/JCPSP.401403 Check
|doi=value (help). PMID 18760061. - ↑ Donoghue HD, Holton J (2009). "Intestinal tuberculosis". Curr. Opin. Infect. Dis. 22 (5): 490–6. doi:10.1097/QCO.0b013e3283306712. PMID 19623062.