Anti-Mycobacterial Antibiotic Therapy Induces Remission in Active Paediatric Crohn’s Disease

Abstract

Crohn’s disease is increasing in incidence and prevalence in younger people and is of a particularly aggressive nature. One emerging treatment targets Mycobacterium avium paratuberculosis (MAP), an organism implicated in the causation of Crohn’s disease. This study reviewed a cohort of paediatric patients with active Crohn’s disease treated with Anti-Mycobacterial Antibiotic Therapy (AMAT). Sixteen paediatric patients, the majority of whom had failed conventional immunosuppressive therapy, were treated with AMAT. Endoscopic remission was scored using the Simple Endoscopic Score for Crohn’s Disease and clinical remission was assessed using the Weighted Paediatric Crohn’s Disease Activity Index (wPCDAI). Inflammatory blood markers were also routinely recorded. Patients were followed up clinically and endoscopically during treatment after an average of two months (range 1–6) and 17 months (range 2–49), respectively. A significant reduction in both scores assessing clinical improvement (p < 0.001) and mucosal healing (p < 0.0078) was observed at these timepoints; 47% of patients had achieved clinical remission and 63% endoscopic remission. Haemoglobin and serum inflammatory markers normalised for more than 50% of the cohort by six months of treatment. No adverse effects were reported throughout treatment. This is the first report of Anti-Mycobacterial Antibiotic Therapy offering a safe and efficacious therapy for paediatric patients with Crohn’s disease. Further larger randomised studies are required in order to validate these findings.

Antibiotics in pediatric inflammatory bowel diseases: a systematic review

“…In most observational studies/case series, the few reported C.difficile infections were mostly in children with recurrent CDI and the rate in children receiving antibiotics did not seem to surpass the incidence reported in IBD populations from current literature [91][92][93]. Only Agrawal et al reported a high percentage of children with CDI, where authors speculate that this is unlikely to be a consequence of antibiotic perturbation of the microbiome since multiple constituents are effective treatments against infection [83]. Turner elaborated on the use of antibiotics in the PRASCO trial (based on non-published data) by explaining that if no response to antibiotics is seen within 3-5 days, the cocktail should be discontinued.…”

“…Remission rate was reached in 21/32 (68%) patients and a significant proportion of the patients achieved normalization of CRP, especially in patients with mild to moderate inflammatory disease involving primarily the terminal ileum and colon [82]. Furthermore, Agrawal and colleagues also showed significant improvement in mucosal healing (SES-CD) in addition to clinical activity indexes in children with moderate to severe CD receiving antimycobacterial antibiotic therapy [83].…”

What is the evidence that mycobacteria are associated with the pathogenesis of Sjogren’s syndrome?

“…There is emerging evidence that targeting MAP with antibiotics in Crohn’s disease may be salubrious [ [73] , [74] , [75] ]. Consistent with their in vitro activity, the combination of clarithromycin, rifabutin and clofazimine, has shown efficacy as a primary treatment for Crohn’s disease [ 76 ].…”

The Post-hunter-gatherer Era Microbes Hypothesis for Chronic Inflammatory Diseases

“…It is not yet known what initiates the inflammatory processes and the other features of IBD. In one of the IBDs, Crohn's disease, an antibiotic combination targeting Mycobacterium avian subspecies paratuberculosis (MAP) infection has been reported to lead to long-term disease remission [147][148][149][150][151]. Agrawal et al [149] discuss recent promising data and addresses several common objections regarding MAP's role, making a compelling case for the involvement of MAP or similar species.…”