In most cases, a short course (one to two weeks) of antibiotics such as ciprofloxacin or metronidazole will decrease or eliminate the symptoms (remission). Improvement in symptoms usually occurs in one to three days. People generally have fewer side effects with ciprofloxacin, and it may be more effective than metronidazole.
About 10 to 20 percent of people develop chronic pouchitis. Many of these people require long-term continuous antibiotic therapy to maintain remission. Supplements of probiotic bacteria can be helpful in preventing pouchitis from returning once it has been treated.
In some people, pouchitis does not respond to antibiotics (called refractory). Mayo Clinic's expertise is often helpful in finding solutions for these difficult problems. Treatment options include:
- Assuring that there's not another explanation for your symptoms
- Topical mesalamine (suppository or enema)
- Oral and topical corticosteroids, such as budesonide
- Immunosuppressive medications, such as infliximab
In rare cases when pouchitis does not respond to any medications, it may be necessary to remove the pouch.
Cuffitis is treated with the same medications used to treat ulcerative colitis, most commonly in the form of a mesalamine suppository (Canasa).
Mayo maintains a database of treatment information about patients, which helps doctors study disease trends and tailor individual treatment plans.
Nov. 20, 2012