Primary treatment of Crohn’s disease: combined antibiotics taking center stage

Abstract

Although controversial, the use of properly chosen antibiotics in Crohn’s disease appears beneficial. Evidence supporting the use of targeted antibiotic therapy comes in two forms: statistical evidence derived from meta-analyses of multiple formal studies and the documented clinical and endoscopic responses in patients treated with antibiotic combinations outside of formal clinical studies. This article reviews evidence from both categories that support the use of properly chosen antibiotic regimens in treating Crohn’s disease, comments on the advantages and disadvantages of antibiotic therapy, and attempts to present a unifying hypothesis related to the role of enteric bacteria, mucosal immunity and antibiotic therapy. Relevant studies identified through a Medline search from 1976 to 2011 were assessed for inclusion by two independent observers who resolved any disagreements by consensus. References from all identified articles and recent review articles were cross-checked to ensure a thorough search. Papers were selected based on scientific merit as to which presented original contributions to the results.

Keywords::

• anti-MAP therapy
• Crohn’s disease
• Mycobacterium avium paratuberculosis

Financial & competing interests disclosure

William Chamberlin owns shares in Harbor Biosciences, the biotech company with patent rights to the immune-enhancing hormone, HE2000. Thomas J Borody has a pecuniary interest in the Centre for Digestive Diseases and Giaconda Ltd, the licensor of Myoconda™, an anti-MAP therapy. Jordana Campbell has no financial interest or affiliation with any institution, organization, or company relating to the manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.