Combined azithromycin and metronidazole therapy is effective in inducing remission in pediatric Crohn's disease

Background: Crohn's disease (CD) is characterized by an aberrant response to the gut microbiota. We aimed to assess whether azithromycin based therapy is effective in inducing remission in CD, due to its effect in inducing apoptosis and efficacy against biofilms and intracellular bacteria. Methods: Retrospective analysis of patients treated with an 8. week course of combined azithromycin and metronidazole. Patients were included if they had active CD defined as pediatric CD activity index (PCDAI) ≥ 10, and were not receiving any other medication for inducing remission in active disease. PCDAI score and CRP were recorded at baseline and 8. weeks thereafter. Results: Thirty two patients (mean age 13.1 ± 3.9, mean duration of disease 0.65. years) were included, of whom 21 (66%) entered clinical remission (PCDAI < 10) after 8. weeks of treatment. The mean age at treatment and duration of disease did not differ between patients entering remission and those unresponsive to therapy. CRP, normalized in 54% of patients with elevated CRP at baseline. Factors associated with lack of response were a more severe disease (reflected by higher PCDAI and CRP values at baseline), presence of arthritis and extensive disease (ileocolonic, or prominent upper intestinal disease). Conclusions: An 8. week course of azithromycin and metronidazole therapy may be effective in inducing clinical remission in mild-moderate luminal CD in children and young adults.