ON THE USE OF ANTIBIOTICS IN CROHNS-DISEASE

It is difficult to understand how a disease process characterized by u lcerations, fissures, abscesses, fistulas, lymphangitis, and granuloma s has not attracted greater use of antibiotics, particularly as the si tes are constantly contaminated by intestinal bacteria. I have had a f avorable experience with broad-spectrum antibiotics in the treatment o f a variety of forms of ileocolitis in animals and now advocate that C rohn's disease be treated at length with these drugs. Microbiologic cu lture of serosa, mesenteric lymph nodes, and fistulas has demonstrated that bacterial species are present in a significant proportion of cas es, and serology has shown that patients have elevated antibody levels to many of these same microorganisms. Now immunocytochemistry provide s documentation of Escherichia coli and streptococcal antigen within t he lesions of a majority of patients. That these bacteria may be secon dary invaders should not decrease our need to address them. Several ch ronic granulomatous diseases that were once thought to be intractable now yield to long-term antibiotic treatment, including Whipple's disea se, malakoplakia, and granulomatous colitis of Boxer dogs. Many of the perianal lesions of Crohn's disease respond to short-term metronidazo le, and the medium-term (3-6 months) use of broad-spectrum antibiotics , most recently ciprofloxacin, has shown ; promising results. In view of the increasing evidence of bacterial participation in this disease, it is now important that physicians test some of our newer broad-spec trum antibiotics, in a controlled format, and over an extended time.