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ABSTRACT

J. Antimicrob. Chemother. 1997 39: 393-400

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Two-year-outcomes analysis of Crohn's disease treated with rifabutin and macrolide antibiotics

GP Gui, PR Thomas, ML Tizard, J Lake, JD Sanderson and J Hermon-Taylor
University Department of Surgery, St George's Hospital Medical School, London, UK

Fifty-two patients with severe Crohn's disease were enrolled in this study. Six (11.5%) were intolerant of the medication and had to be excluded. The remaining 46 patients were treated with rifabutin in combination with a macrolide antibiotic (clarithromycin or azithromycin). Patients were treated for a mean of 18.7 (range 6-35) months and followed up for 25.1 (range 7-41) months. Of the 19 patients who were steroid dependent at the start of this study, only two continued to require steroids when treatment was established. A reduction in the Harvey-Bradshaw Crohn's disease activity index occurred after 6 months' treatment (P = 0.004, paired Wilcoxon test) and was maintained at 24 months (P < 0.001). An improvement in inflammatory parameters was observed as measured by a reduction in erythrocyte sedimentation rate (P = 0.009) and C-reactive protein (P = 0.03) at 18 months compared with pretreatment levels, and an increase in serum albumin at 12 months (P = 0.04). When subsets of the study population were analysed, patients with pan-intestinal disease achieved better remission at 2 years than did those with less extensive involvement (P = 0.04, Mann-Whitney U-test). No difference in treatment response by age, disease duration, the presence of granulomas on histology, or the occurrence of drug-induced side-effects, was observed. These data suggest that treatment with rifabutin and clarithromycin or azithromycin may result in a substantial clinical improvement in Crohn's disease and justify the conduct of a randomized controlled trial.


PARA's SUMMARY

AT THIS POINT IN TIME, THERE HAD BEEN NO CONTROLLED TRIALS OF ANTIMYCOBACTERIAL TREATMENT OF CROHN'S DISEASE. REASEARCHERS HERE MAKE THE CASE FOR CONDUCTING SUCH TRIALS.


Source: http://www.crohns.org/articles/1997_00_393-400_jac.htm   Contact PARA: http://www.crohns.org/contact.htm
Paratuberculosis Awareness & Research Association