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Long story, but if you have experience with antibiotics, I'd appreciate thoughts. Skipping  to end for questions would be just fine!

I do not have pouchitis.  But I rely on antibiotics to avoid leaking day and night and that twitching-like sensation that signals "stay close to the bathroom" during the day.  Likely this relates to having no cuff, so more prone to leaking.

I've used Flagyl + Cipro, Cipro alone, and Rifaximin.   The first time I switched to Rifaximin was a fail. I returned to Cipro 500 bid.  Second time trying I overlapped the drugs for few days and was able to transition to Rifaximin 550 bid.  Good days, still minor leaking at night.   When insurance stopped covering Rifaximin I returned to Cipro 500 bid while I waited for delivery of Rifaximin ordered from India.  

I noticed a difference in how I felt back on Cipro.  Stool was darker, firmer, and absolutely controlled leaking.   When Rifaximin arrived, based on prior experience I overlapped the two, using both Rifaximin 550 and  Cipro 250 bid.  I actually kept this up for over a week because I had to travel for work.  First time since my surgery almost a year ago that I ate dinner at a normal hour and chanced a glass of wine. No problems and good sleep.  Felt about as normal as I imagine I could feel.

Back at home, I reduced the Cipro. My stool got softer, lighter, and leaking is starting up as I drop the dose.

I'm aware of the risk of tendon rupture in this class of antibiotics including Cipro, the main reason the specialists at Columbia won't keep ordering it.  But my local GI will prescribe for me if I ask  

So, questions: For anyone who maintains with Cipro, what's your minimum dose and do you combine it with other drugs? How long have you been on it? Any experience with Rifaximin? Other experience/ advice with moving between antibiotics?

Original Post

I’ve been on Cipro since about 2008-2009. I experimented with the dose to minimize it, settling on 500 mg once per day at bedtime. It began to lose effectiveness for me about 7 years ago, and I added Flagyl: the combination is still working well. Rifaximin alone never worked for me, but I haven’t tried it in combination. As a precaution I did get an abdominal ultrasound a couple of years ago, to make sure the Cipro hadn’t affected my aorta. I probably do get more tendinitis than I would without the Cipro. YMMV.

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