Pre-treatment With Azithromycin to Reduce Immunogenicity to Anti-Tumor Necrosis Factor-α Agents in Patients With Inflammatory Bowel Disease

This will be a randomized placebo-controlled trial in inflammatory bowel disease patients before initiation of anti-tumor necrosis factor-α (anti-TNF) therapy that aims to test the effect of a pre-treatment short course of azithromycin therapy on immunogenicity

Inclusion Criteria:All consenting adult (≥18 years) IBD patients starting infliximab or adalimumab therapy.Exclusion Criteria:Inclusion in another interventional studyPatients who cannot provide informed consent and do not have a legal guardianPatients with perianal involvement that are expected to require antibiotic therapy for their diseasePatients on chronic antibiotic therapy due to any causeCrohn's Disease complication requiring surgical treatmentPlanned/ongoing methotrexate co-therapyPregnancyPatients who received azithromycin therapy in the previous year (we will not exclude prior use of other antibiotic therapy)