Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Orlando, October 22-24, 1998
PROLONGED REMISSION OF CROHN'S DISEASE FOLLOWING TREATMENT OF CHILDREN, ADOLESCENTS AND YOUNG ADULTS WITH CLARITHROMYCIN
The cause of Crohn's disease (CD) is unknown. A proposed etiology is Myocobacterium paratuberculosis (M para), the cause of Johne's disease in cattle which pathologically resembles CD. M para has been identified in the intestinal tissues from some patients with CD by PCR. One of the most effective antimicrobial agents against M para is clarithromycin (clari). We treated 13 children (17mon-23y, 9F) having refractory CD with clari (15mg/d divided bid, max dose 500mg bid) for 6 months in an open label clinical trial. Monthly clinical and laboratory evaluations including PCAI scores were performed for 12m: 6m while receiving clari and 6m after completing clari treatment. Compliance was assessed by pill count. All other medications were adjusted as clinically indicated by the attending physician. 84% of the patients improved their PCAI scores. Compared with initial values, average PCAI scores decreased by 64% at 6m and 62% at one year (Table 1). Significant reductions in corticosteroid doses were achieved by 80% of patients at 6 mo and this reduction was sustained by 88% of these patients at ly (Table 1). Fistulas in two patients, one perianal (of 6y duration) and one enterocutaneous (recent, post-surgical), both healed on clari therapy. These preliminary data indicate that clarithromycin may be useful in the treatment of patients with refractory CD. The drug's effect may be mediated through antimicrobial activity (against M para or other enteric microflora) or by non-specific immunomodulatory effects.
Intestine/Colon/IBD© 1998 Lippincott Williams & Wilkins, Inc.