This page is designed to explain a typical RMAT (Rifabutin and
What is RMAT?
RMAT (Rifabutin and macrolide antibiotic therapy) is an antibiotic
"cocktail" consisting of Mycobutin (rifabutin) and Biaxin (clarithromycin).
Along with the antibiotics, we also prescribe probiotics (good bacteria)
to maintain the intestinal flora. (Note: Some researchers are also using
How does it work?
RMAT is effective against mycobacterium avium subspecies paratuberculosis
Biaxin (clarithromycin) exerts its antibacterial action by binding to the
50S ribosomal subunit of susceptible microorganisms resulting in inhibition
of protein synthesis. Mycobutin (rifabutin) interferes with the activity
of enzymes needed for the replication of RNA (ribonucleic acid) in bacterial
cells, thus preventing the bacteria from reproducing.
Is RMAT effective for all Crohn's Disease patients?
Unfortunately no, RMAT is only effective in patients where the Crohn's
is triggered or aggravated by the MAP infection. Our research has shown
that approximately 70% of patients receiving RMAT have gained remission.
(Based on a CDAI score of 150 or less) Please read more about this in our
MAP Research section.
How do I know if I have a MAP infection?
At this time there is no commercial test for the MAP bacteria, however,
we are currently working with another researcher who is developing a serological
test for MAP antibodies. At the moment, we are preparing protocols and
procedures for efficient testing. We are anxiously awaiting a source for
testing sera for MAP and hope to have something soon...
Clarithromycin (Biaxin), Rifabutin (Mycobutin) and a comprehensive
probiotic product with at least 8 lactic acid bacteria (available at health
food, grocery, and drug stores) are used in combination to reduce the population
of the MAP bacteria and to repopulate the intestinal flora with "good"
Clarithromycin (Biaxin): 250 mg twice per day or 500 mg Biaxin XL once
Mycobutin (Rifabutin): 150 mg twice per day
Probiotic: Two per day, not taken at the same time as the antibiotic
The typical RMAT treatment is between 1 and 2 years. The duration of
an individual patient is dependent on the speed of the reduction of the
Please note the following links will open in a new window and are not
hosted by us.
RMAT Treatment FAQs
I am currently on other medication, can I continue to take them while
The answer to this is a reserved "yes". You MUST
inform your doctor of all medication you are taking, this includes any
over-the-counter medication or herbal/dietary supplements. Ask your pharmacist
to check for adverse interactions with your medication. This is a good
practice, on whatever treatment you decide.
What side effects may I expect?
The most common side effects reported with this treatment are flu-like
symptoms for the first couple of weeks. The RMAT treatment is well tolerated
with most people. For a list of possible side effects please read the Trial
My doctor said that antibiotics have been tried before but failed.
Your doctor is absolutely right. Clinicians have attempted to treat
Crohn's with antibiotics since the mid 70s. The antibiotics used at that
time were ineffective against MAP infections. It was not until the invention
of macrolide antibiotics in the late 80s that effective drugs became available
for MAP infections.
My doctor is unwilling to try RMAT, what can I do?
It is not the intention of this website to second-guess your doctor's
medical opinion; however, if you feel that you doctor has not given RMAT
a fair hearing, and you believe that you may benefit from RMAT, please
seek a second opinion.
If you still have questions please contact us.