Most people with pouchitis are treated with 10 to 14 days of antibiotics such as ciprofloxacin (Cipro) or metronidazole (Flagyl), usually given orally. Ciprofloxacin generally produces fewer side effects and may be more effective than metronidazole.
Other antibiotics used include rifaximin (Xifaxan) and amoxicillin/clavulanate (Augmentin). Sometimes antibiotics are given in combination.
While most people respond well to treatment, 5-19 percent develop relapsing or treatment-refractory disease. This form of pouchitis might require long-term, continuous antibiotic therapy. Probiotic bacteria supplements have been found helpful in preventing pouchitis from returning once it has been treated, although more studies are needed.
Chronic antibiotic refractory pouchitis (CARP)
In some people, pouchitis does not respond to antibiotics. Doctors at Mayo Clinic can help find solutions, which include ruling out other causes for your symptoms. Medications include:
- An anti-inflammatory drug, mesalamine (Apriso, Asacol, others), either oral or as a suppository (Canasa) or enema
- Oral and topical corticosteroids, such as budesonide or hydrocortisone
- Immunosuppressive (anti-tumor necrosis factor or TNF) medications such as infliximab (Remicade) or adalimumab (Humira)
No data is available on fecal transplantation in CARP.
In rare cases when pouchitis does not respond to any medications, it may be necessary to remove the pouch.
June 11, 2015
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