A 41 year old male patient presented with recurrent episodes of bloody diarrhea for 5 years. Despite regular treatment with adequate doses of sulfasalazine, he has had several exacerbations of his disease and required several weeks of steroids for the control for flares. What should be the next line of treatment for him?
Correct Answer: Azathioprine
Description: Ans. is 'b' i.e. AzathioprineRef Harrison 17th/e p 1896 & 16th/e p 1785 (15th/e p1688), Goodman Gilman 10th/eThis is a case of ulcerative colitis as suggested by the recurrent episodes of bloody diarrhoea.The pt. has been on maintenance therapy with sulfasalazine but it is not able to maintain the patient in remission and he needs corticosteroid for the control of his exacerbations.So, he now needs a drug which can maintain him in remissionFor this go through the role of immunosuppressant is ulcerative colitis.AzathioprineAzathioprine and 6 mercapto- purine are effective in long term management of ulcerative colitis. They reduce the requirement of steroids in patient as well as maintain the patient in remissionCyclosporine -It greatest value is in t/t of acute severe ulcerative colitis that does not appear to be responding adequately to glucocorticoid. However it does not reduce the rate of relapse and is not effective as maintenance therapy. So it is used for short term management of ulcerative colitis.Methotrexate Methotrexate is useful in steroid dependent on Crohn's disease but it has no use in ulcerative colitis.Cyclophosphamide has no role in the management of either Crohn's disease or ulcerative colitis.
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