Offer monotherapy with a conventional glucocorticoid (prednisolone, methylprednisolone or intravenous hydrocortisone) to induce remission in people with a first presentation or a single inflammatory exacerbation of CD in a 12-month period.

In people with distal ileal, ileocaecal or right-sided colonic disease who decline, cannot tolerate or in whom a conventional glucocorticoid is contraindicated, consider budesonide. Explain that budesonide is less effective than a conventional glucocorticoid but may have fewer side effects.

In people who decline, cannot tolerate or in whom glucocorticoid treatment is contraindicated, consider 5-aminosalicylate (5-ASA) treatment for a first presentation or a single inflammatory exacerbation in a 12-month period. Explain that 5-ASA is less effective than a conventional glucocorticoid or budesonide but may have fewer side effects.

Do not offer budesonide or 5-ASA treatment for severe presentations or exacerbations.

Do not offer azathioprine, mercaptopurine or methotrexate as monotherapy to induce remission.