Which therapies are advisable in pouchitis?

Antibiotics Antibiotics are the mainstay of treatment. Usually ciprofloxacin and metronidazole represent the most common first therapeutic approach, and most patients with acute pouchitis respond quickly to administration of 1 g/day. In a small randomized clinical trial, ciprofloxacin 1 g/day and metronidazole 20 mg/kg/day were given for 2 weeks. Both drugs significantly reduced the total Pouchitis Disease Activity Index (PDAI) scores; however, ciprofloxacin led to a greater degree of reduction in total PDAI score, to a greater improvement in symptoms and endoscopic scores, and furthermore, was better tolerated (33% of metronidazole-treated patients reported adverse effects such as nausea, vomiting, abdominal discomfort, headache, skin rash, dysgeusia, and peripheral neuropathy, compared with none of ciprofloxacin-treated patients).1 Therefore, ciprofloxacin should be considered the first-line therapy for acute pouchitis.

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