What role do you feel there is for antibiotics in the management of severe perianal Crohn's disease?

Without access to biologics you still should have access to a thiopurine. That has some efficacy and was all we had prior to biologics along with chronic antibiotics.

There isn't high quality data to answer this. I use antibiotics for perianal disease in the setting of an abscess, inflammatory stranding in the surrounding or during period of increased activity (purulent drainage, pain). One should always consider if an abscess needs to be drained (+/- EUA) or a s...