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Two-year outcomes analysis of Crohn's Disease treated with rifabutin and macrolide antibiotics.
This paper was published by Gui et al., based in St Georges Hospital Medical School, where the IS900 insertion sequence, which uniquely identifies M. paratuberculosis, was discovered. In this paper they describe the outcome of treating 52 patients with a combination of rifabutin and the newer macrolide antibiotics, clarithromycin and azithromycin.
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Here is a summary of the main points from the paper.
- Six of the patients had to be excluded because they were intolerant of the medication.
- Of the remaining forty six patients, clinical remission (Harvey-Bradshaw Crohn's disease activity index < 5) was achieved in 43 patients, 93.5%.
- Of nineteen patients that were steroid dependent at the beginning of treatment, only two were steroid dependent when treatment was established.
- Patients with more severe symptoms achieved better remission than did patients with more moderate symptoms. This may be because improvement is more readily detected in patients with aggressive disease.
- Fifteen of the patients required surgery, many more than would be expected. It appears that antibiotic treatment, by inducing healing, also accelerates stricturing and scar-tissue formation. These strictures must be surgically removed. In ten cases the surgery was for the removal of strictures, in three cases for fistulas or abscesses, and in two cases for uncontrolled inflammation.
- It summarises by asserting that the data presented as a result of the study justify the conduct of controlled clinical trial to test the efficacy of the drugs used against Crohn's disease.
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Anti-mycobacterial treatment and Crohn's Disease.