Antibacterial therapy for Crohn's disease: A review emphasizing therapy directed against mycobacteria

The most commonly used antibiotics in Crohn's disease are nitroimidazoles a nd macrolides often combined with corticosteroids or sulfasalazine. There h as been interest in a mycobacterial involvement in Crohn's disease since it s earliest description. It is not recognized that paratuberculosis avium 2 subspecies paratuberculosis a proven but uncommon cause of human disease, i s widespread in the human food chain especially in dairy products and beef. M. paratuberculosis has been identified in tissues from a higher proportio n of Crohn's disease patients than controls, suggesting that it may be one of the causes of Crohn's disease. We review the large number of antibiotic trials in Crohn's disease. Although studies have been performed with many d ifferent protocols and variations in the definition of success, preliminary reports of multiple drug therapies are encouraging. Nevertheless, large-we ll designed preferably placebo-controlled studies are needed before one cou ld recommend such therapy.