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Severe recurrent Crohn’s disease of ileocolonic anastomosis and antimicrobial (anti-mycobacterial) therapy

¹ Centre for Digestive Diseases, Sydney, Australia
² National Jewish Medical and Research Center, Denver, USA

Correspondence to:
Correspondence to:
Professor T Borody
Centre for Digestive Diseases, 144 Great North Road, Five Dock, NSW, 2046, Australia; tborody@zip.com.au

Keywords: Crohn’s disease; ileocolonic anastomosis; antimicrobials

The first 150 words of the full text of this article appear below.

Elliott et al (Gut 2005;54:1818–19) presented an interesting and clinically useful finding of successful treatment of a patient with severe Crohn’s disease and circumferential narrowing of the ileocolonic anastomosis with 750 mg ciprofloxacin plus 400 mg metronidazole daily for almost three years, resulting in complete healing and opening up of the stenosed anastomosis.

The authors list a number of bacterial species known to be susceptible to these antibiotics. However, they have omitted perhaps the most important potential pathogen, Mycobacterium avium ss paratuberculosis (MAP), the leading candidate causal agent of Crohn’s disease.^1,2 It is well known that ciprofloxacin exhibits marked activity against Mycobacterium avium.³ It is also known that metronidazole can be bactericidal against dormant M tuberculosis in anaerobic conditions.⁴ Although no such data are yet available concerning other mycobacteria, the role of metronidazole in affecting MAP cannot be excluded when these bacteria persist under anaerobic . . . [Full text of this article]

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