Viewpoint: The Use of Antimycobacterial (Anti-MAP) Therapies in the Treatment of Active Luminal Crohn's Disease

Mycobacterium avium subspecies paratuberculosis (MAP) as the infectious cause of Crohn's disease and the use of antimycobacterial (anti-MAP) therapies in its treatment remain topics of controversy. A major limitation accepting this view is that irrefutable evidence that MAP causes Crohn's disease—the demonstration that long-term remission follows clearance of the infection with antibiotics—has been lacking. While several centers continue to advocate their use, most authoritative guidelines do not recommend anti-MAP regimens. This viewpoint aims to evaluate current data, in particular, the results of randomized controlled trials (RCTs) of anti-MAP therapy published in 2007 and in 2024. We conclude that, similar to several other antibiotic regimens, the benefit of anti-MAP therapy in active Crohn's Disease (CD) is likely to be modest. Continuing treatment is unlikely to be of benefit if there is no significant objective improvement in disease activity by 16 weeks. Any beneficial effect of anti-MAP therapy is not maintained after its discontinuation. There is still no convincing evidence that the causative microorganism of Crohn's disease is Mycobacterium avium ssp. paratuberculosis in significant numbers of patients.