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Walk the Even Hospital Database by book and chapter — the raw source passages that ground Ask, DDx, and the rest.
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©2013 UpToDate ® Print Email Algorithm for management of refractory Crohn's disease in children 6MP: 6-mercaptopurine; AZA: azathioprine; MTX: methotrexate. * Either infliximab or MTX are reasonable choices in this situation. Infliximab has been better studied than methotrexate, and often induces remission in patients who fail immunomodulators. The decision is based on any patient-specific risk factors (eg, risk of pregnancy for patients on MTX), and patient-specific values and preferences (eg, concerns about subcutaneous route of administration for MTX, or intravenous infusions and risk of pulmonary infections on infliximab). Infliximab with low dose methotrexate (7.5 mg/M 2 /week) is being increasingly used as combination therapy. For a discussion of these issues, refer to the text of the UpToDate topics on management of Crohn's disease with these medications. • Expert opinion varies about how long to continue combination therapy after starting infliximab. For a discussion of the relative risks and benefits, refer to the text of the topic on management of Crohn's disease in children and adolescents. Modified with permission from: Faubion WA, Bousvaros A. Medical therapy for refractory pediatric Crohn's disease. Clin Gastroenterol Hepatol 2006; 4:1199.