I agree, it makes sense to opt for antibiotic treatment as a first option. But, if you are not symptomatic while having chronic inflammation, it is a little more tricky. Also, if your doctor is quite convinced this is more likely to be Crohn’s of the pouch, and not the ordinary run-of-the-mill pouchitis, a more aggressive approach may be considered. Hopefully, when you are at your next appointment, you will get the full details about your doctor’s plans. Make sure to ask all the questions you asked us. Protocols are changing all the time.
And yes, I am on biologics for chronic pouchitis. But, I did try antibiotics first. I became antibiotic dependant and was rotating three different antibiotics. Bottom line, my GI felt that the long term risks of chronic antibiotic use were worse than the risks of biologics. Plus, understand, I had already been on biologics for years for enteropathic arthritis. The main change was to Remicade and adding Imuran.