title: Effects of interactions of antibacterial drugs with each other and with 6-mercaptopurine on in vitro growth of Mycobacterium avium subspecies paratuberculosis.
abstract: OBJECTIVE
  Mycobacterium avium subspecies paratuberculosis (MAP) has been targeted for treatment with clarithromycin and rifamycin derivatives in numerous cases of Crohn's disease (CD). 6-Mercaptopurine and its pro-drug azathioprine are widely used as immunomodulators in the treatment of CD and have recently been shown to have anti-MAP activity in vitro. The objectives of the study were to evaluate the in vitro effects on MAP of (i) 6-mercaptopurine when combined with each of eight conventional antibacterial agents with in vitro anti-MAP activity and (ii) antibacterial combinations consisting of two drugs (clarithromycin combined with amikacin, rifampicin, ciprofloxacin or ethambutol) and three drugs (clarithromycin, rifabutin and clofazimine).
  
  
  METHODS
  The drug interaction effects on nine human isolates of MAP were determined by the chequerboard method adapted for the BACTECMGIT960 culture system and by calculation of the fractional inhibitory concentration index (FICI) for drug combinations.
  
  
  RESULTS
  Synergism (FICI < or = 0.5) was observed between 6-mercaptopurine and azithromycin (seven isolates), clarithromycin, rifampicin, rifabutin (four isolates each) and ethambutol (two isolates). 6-Mercaptopurine was not antagonistic with any of the antibacterial agents tested. Among the combinations of two and three antibacterials tested, the clarithromycin/rifampicin combination was synergistic against four isolates, while all other combinations showed no interaction.
  
  
  CONCLUSIONS
  This in vitro study suggests that 6-mercaptopurine may be synergistic with macrolides and rifamycin derivatives against MAP. The activity of clarithromycin against MAP seems to be enhanced by rifampicin.
authors.affiliation: Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706-110, USA.
authors.forename: Manju Y
authors.initials: MY
authors.lastname: Krishnan
authors.forename: Elizabeth J B
authors.initials: EJ
authors.lastname: Manning
authors.forename: Michael T
authors.initials: MT
authors.lastname: Collins
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D004347:Drug Interactions; D006801:Humans; D007155:Immunologic Factors / Q000494:pharmacology*; D015122:Mercaptopurine / Q000494:pharmacology*; D008826:Microbial Sensitivity Tests / Q000379:methods; D016927:Mycobacterium avium subsp. paratuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D010283:Paratuberculosis / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D007155:Immunologic Factors; D015122:Mercaptopurine