Which medications are commonly prescribed during acute exacerbations of ulcerative colitis?

• A. Amoxicillin
• B. Ciprofloxacin
• C. Metronidazole
• D. Flagyl and ciprofloxacin

Answer: (D)

When ulcerative colitis flares, antibiotics are used when an infection or complication is suspected to prevent further deterioration. The goal is to cover a broad range of gut bacteria that could be involved, including anaerobes and Gram-negative organisms.

Metronidazole targets anaerobic bacteria effectively, while ciprofloxacin covers many Gram-negative aerobes. Using them together provides broad-spectrum coverage that's useful when the exact infectious cause isn’t yet known or when mixed bacterial flora may be contributing to the acute worsening. This combination addresses the likely organisms involved in infectious or complicated colitis scenarios, which is why it’s commonly prescribed in acute exacerbations.

Other options fall short because single agents either miss anaerobic coverage or miss aerobic Gram-negative coverage, making them less suitable for empiric therapy in this context.