Rifabutin and Macrolide Antibiotic Treatment in Crohn’s Patients Identified Serologically Positive for Mycobacterium avium ss. paratuberculosis

I. Shafran, C. Piromalli, S. Naser

The use of antibiotics in Crohn’s disease has recently been studied and our group has shown previously the efficacy and safety of RMAT in an open clinical trial. Forty-two Crohn’s patients, who were serologically positive with the p35 and p36 serologic markers specific for  Mycobacterium avium ss. paratuberculosis (MAP), were chosen for treatment with Rifabutin and Macrolide Antibiotic Therapy (RMAT). The RMAT medications included 250 mgm 1 po bid clarithromycin and 150 mgm 1 po bid rifabutin and 200 mgm po bid of a probiotic containing equal amounts of Lactobacillus acidophilus and Lactobacillus rhamnosus. These patients were followed serologically and clinically each month. The serial blood samples were stored to measure, at a later date, the quantitative antibody response to MAP.   All of the patients were assessed to determine their overall response to treatment. The period of treatment ranged from 3 months to 17 months with the average treatment period being 12 months. 61.9% (26/42) of the patients reached a sustained state of clinical remission (defined by the CDAI criteria with a score <150) while being off all other Crohn’s medications, such as sulfasalizine and corticosteroids. The majority of these patients had acute presentations of Crohn’s disease when placed on RMAT. 5 patients also had documented endoscopic healing correlating with treatment response.  9.5% (4/42) of patients noticed significant improvements but were still using Crohn’s medications with RMAT.  9.5% (4/42) were nonresponders noticing no marked improvement while on RMAT. 19.1% (8/42) of patients were unable to tolerate the RMAT medications and stopped therapy.  These findings add further evidence to support the role of RMAT in the treatment of Crohn’s disease in patients serologically positive for MAP. A large multicenter clinical trial is needed to further explore these findings.

RMAT CLINICAL TRIAL RESULTS

All content copyright ©1999 Dr. Ira Shafran, M.D.

Back To Publications