Open clinical trial of rifabutin and clarithromycin therapy in Crohn's disease

    Authors

    I. Shafran; L. Kugler; F. A. K. El-Zaatari; S. A. Naser;J. Sandoval

    Abbreviated Journal Title

    Dig. Liver Dis.

    Keywords

    anti-mycobacterial antibiotics; Crohn's; macrolide antibiotics; Mycobacterium avium subsp; Paratuberculosis; AVIUM SUBSP PARATUBERCULOSIS; JARISCH-HERXHEIMER REACTION; MYCOBACTERIUM-PARATUBERCULOSIS; ANTIMYCOBACTERIAL THERAPY; ANTIGEN; METRONIDAZOLE; PATHOGENESIS; ANTIBIOTICS; ANTIBODIES; DNA; Gastroenterology & Hepatology

    Abstract

    Background, Crohn's disease, an inflammatory bowel disease in humans, has a suspected aetiology of Mycobacterium avium, subsp. Paratuberculosis, Aims. To evaluate the role of rifabutin and clarithromycin anti-Mycobacterium avium subsp. Paratuberculosis treatment in Crohns disease patients using an open clinical trial. Methods. A total of 36 patients with acute presentations of Crohn's disease, whose sera tested positive against p35 and p36 antigens (two recombinant proteins Of Mycobacterium avium subsp. Paratuberculosis), were selected for treatment with rifabutin and macrolide antibiotic therapy Rifabutin and macrolide antibiotic therapy medications included 250 mg I po bid clarithromycin and 150 mg I po bid Rifabutin accompanied with a probiotic. Crohn's disease patients' response to rifabutin and macrolide antibiotic therapy was monitored over a period ranging from 4 to 17 months. Results. Seven patients (19,4916) withdrew from the study since they were unable to tolerate medications, Of the remaining 29 patients, 21 (58.3%) reached a sustained state of improvement, traditionally defined as a decrease of 70 points between their entrance and exit Crohns disease activity index scores together with the absence of the need of all other Crohn's medications, such as immunosuppressants and corticosteroids, Three Crohns disease patients (8.3%) noticed significant improvements, but required other Crohns medications, concurrently with rifabutin and macrolide antibiotic therapy, to achieve and sustain improvement. Only 5 Crohn's disease patients (13.8%) were non-responders, noticing no marked improvement while on rifabutin and macrolide antibiotic therapy Conclusion. The data add further evidence to support the role of rifabutin and macrolide antibiotic therapy in the treatment of Crohn's disease specifically in those patients with evidence of Mycobacterium, avium subsp. Paratuberculosis infection. A large multi-centre clinical trial is needed to further explore these findings.

    Journal Title

    Digestive and Liver Disease

    Volume

    34

    Issue/Number

    1

    Publication Date

    1-1-2002

    Document Type

    Article

    Language

    English

    First Page

    22

    Last Page

    28

    WOS Identifier

    WOS:000174325700006

    ISSN

    1590-8658

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