RMAT Treatment

This page is designed to explain a typical RMAT (Rifabutin and Macrolide Antibiotic Therapy) protocol. 

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 clofazimine.) 

How does it work?
RMAT is effective against mycobacterium avium subspecies paratuberculosis (MAP). 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" bacteria. 

Clarithromycin (Biaxin): 250 mg twice per day or 500 mg Biaxin XL once a day. 
Mycobutin (Rifabutin): 150 mg twice per day 
Probiotic: Two per day, not taken at the same time as the antibiotic doses. 

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 MAP bacteria. 

Medication Information:
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RMAT Treatment FAQs

I am currently on other medication, can I continue to take them while on RMAT?
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 Results

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.

The information contained in this site is intended for information purposes only and is not intended as a means of diagnosing or treating disease. Please consult your doctor before starting any treatment.