Personalized AZithromycin/metronidAZole + Dietary Therapy in Pediatric Crohn Disease: Results of a Pilot Study

Current pediatric Crohn’s disease treatment often relies on early immune suppression, but growing evidence highlights the role of the gut microbiome and nutritional therapy in disease management. This pilot study explored whether microbiome-based prediction could be feasibly integrated into early treatment decisions for children with mild-to-moderate Crohn’s disease receiving the Crohn’s Disease Exclusion Diet (CDED) with partial enteral nutrition (PEN).

Using baseline stool samples and a Bayesian prediction model, researchers aimed to identify children at higher risk of relapse and tailor treatment accordingly, including the addition of targeted antibiotics. The study demonstrated that centralized microbiome sequencing and prediction could be completed within four weeks for most patients, meeting the primary feasibility goal.

However, children with microbiome signatures associated with relapse generally did not achieve early remission with nutritional therapy alone, limiting the practicality of the proposed treatment allocation strategy. While the study was not powered to assess efficacy and was stopped early, it represents an important first step in prospectively applying microbiome-based prediction to guide personalized treatment in pediatric Crohn’s disease.

Overall, the findings support the feasibility of microbiome-informed treatment stratification and highlight the potential, and current limitations, of integrating personalized nutritional and microbiome-based approaches into Crohn’s disease care.

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