Antibiotics as primary therapy for Crohn's disease

Crohn's disease, an inflammatory bowel disease of unknown cause, was initia lly considered to have an infectious etiology. As the infectious agent coul d not be identified, it was grouped among the immune disorders. As a result , research and clinical trials were directed towards the autoimmune theory and patients were treated with steroids, immunomodulators, aminosalicylates and, most recently, anti-tumor necrosis factor-alpha. Because of the incon sistency of treatment success and the failure to cure Crohn's disease, many physicians turned to antibiotics in search for alternative solutions, espe cially when other regimens failed. Attention has recently been directed tow ard possible infectious causes of Crohn's disease. Although it is still unk nown whether microbial agents are etiologically involved in the pathogenesi s of Crohn's disease, there has been a growing interest in trying antibioti cs in the management of Crohn's disease. This review summarizes the data av ailable regarding antibiotic treatment of Crohn's disease in relation to a possible mycobacterial etiology. Multidrug therapies are in clinical trials and the results of these randomized, controlled,:double-blind studies are needed before guidelines about whether to include antibiotics as part of th e treatment of Crohn's disease management can be made. (C) 2000 Prous Scien ce. All rights reserved.