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I've had my pouch since 2000.  I also have had recurrent pouchitis throughout the last 16 years.  For that reason, I was put on Flagyl and Cipro, long term.  I tolerated both well until getting peripheral neuropathy in my feet and hands about 2 years ago and Flagyl was stopped.  I was then solely on Cipro for pouchitis and entocort.  This year, I became quite ill from C Diff and Cipro was stopped.  I tried several other drugs to no avail until my second round of Difficid.  Shortly after the C diff was gone, I became sick again w Pouchitis, as I was not on any antibiotics at that time.  I was again put on Cipro for a two week course which seemed to clear up the pouchitis.  Two weeks or less, I had pouchitis again.  I was put on Cipro for long term preventative of pouchitis.  My gut is fine now and has been for a month or two, however, my joint and muscle pain etc has gotten worse and worse to the point that my knees can no longer support me even lowering myself to the toilet, my hands are so painful that it is hard to do just simple tasks, my feet and ankles hurt with every step, as if (particularly when I get up in the am or middle of the night) I am walking on broken bones.  I have been to the rheumatologist and my blood work is negative for RA.  Though my hands and knees are swollen, he still didn't think I have RA.  

A few nights ago I told my husband that I could not keep living like this.  That night, I had an "ah ha" moment and wondered if any of my agonizing symptoms were Cipro related.  My GI doc had said that the only thing to watch for is pain in my Achilles' tendon because there is a very rare chance of rupture.  When I heard this a few months ago, I said, "well, I have been on Cipro for so many years and haven't had any adverse reactions, I'll be fine".  I had forgotten about what he said until the other night when it occurred to me that maybe it is not just the Achilles' tendon and I did some in the middle of the night research.  Much to my great surprise, there was a lot of information on the same symptoms of "hurting from head to toe" related to being on Cipro.  In the past, when I had been on Cipro, most of the time I also had pouchitis, so my doctor and I always assumed that my joints were hurting because of the gut inflammation (enteropathic arthropathy), and the other times, my doc would tell me that one can have the systemic enteropathic arthritis even when the gut or pouch is not inflamed.  I NEVER EVER thought of Cipro being a culprit, and historically after getting off of the Cipro, eventually my joints would get better and at that point, My pouchitis was absent.  The other night when  I heard my new GI doc's ( my old GI retiring after having been with him for 27 years!) voice whispering about Achilles' tendon rupture, was the first time I had EVER considered Cipro as the cause of this progressive musculoskeletal pain.

 I stopped Cipro two days ago and will remain off of it.  However, as my primary doc said "you NEED to find another medicine that you can be on to prevent pouchitis, in place of the Cipro".  That is what I need to know.  My current GI doc said that he didn't know of the best antibiotic to use but that he would "investigate".  That doesn't give me a lot of faith.  I have more faith in what you all have used and the success rate, of an antibiotic other than Cipro or Flagyl that I can be on that won't have these debilitating side effects.  That being said, I am not certain yet that the Cipro is responsible for the joint, muscle, tendon pain.  It is just my theory at this point, because nothing else makes sense!  Out of the blue, these symptoms again show up?  I am just praying that the symptoms will go away, as they have done before.

PLEASE let me know 1) if you have ever had this type of adverse effect from Cipro 2) what antibiotic have yo used to replace Cipro.

Thank you all so much.  I apologize for the lengthy entry/post.

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There are a fair number of other antibiotics used for pouchitis. If I were in your situation I'd try Xifaxan (rifaximin) next  - make sure your doctor doesn't use the low dose that's recommended for traveler's diarrhea. Xifaxan is very expensive, though. Other choices include Tindamax, Augmentin, and a few others. Good luck!

I've had my jpouch since 2001 and have had pouchitis on and off ever since. But I've used flagyl suppositories to keep it in check for at least 13 years.  there are zero side effects since very little is absorbed into the blood stream unlike oral medications.  They work almost instantly, a few days at most.  I just had a scope and my doctor was amazed at how there was no inflammation.  I would highly recommend the suppository route if concerned about antibiotic reactions.  

I do have quite a bit of Achilles pain in my left Achilles. I've brought it up with my doctors but they never seem to take it very seriously. This has been for a few years now.

I have an appointment coming up with my new GI in the next month and I'll bring it up again.  This guy has been great and is working with me on some things to try other than just take Cipro forever (which I have been doing since 2007 - 10 years now). I've been taking Lialda recently along with Cipro, so I'm hoping to try going back to Xifaxan along with the Lialda and cycle off Cipro if possible soon. We'll see. In the past if I go off Cipro I am non-functional within days.

 

Last edited by DJ H

Augumentin and xifaxin work great. Also I have psoriatic arthritis and developed it about 5 years after my JPouch. My bloodwork came back negative too, but the inflammation I was having in my joints was clear it was arthritis. I eventually had to go on Enbrel which worked beautifully. You need to explore options bc severe joint pain is awful and can be prevented with treatment. Good luck! 

I've had the same effects from cipro... and if you get them the side effects come faster.  When discussing them with medical professionals it seems 50-50... some will say "oh it's the flagyl" while others say "oh it's the cipro".  Has anyone got an idea or been tested to see which one it is?  I would try one or the other to see while I'm looking for an alternative but not both again.  

Tracy Bug thanks for posting on this. You've put the puzzle together with a re-exposure, as did I.

MUCH more awareness is needed amongst us Jpouchers who can be prescribed a lot of flouroquinolones and therefore represent a higher risk group for experiencing these awful adverse effects aka FQAD or 'flouroquinolone associated disability'. sadly, when we start getting any of these well documented side effects, they are usually attributed to an autoimmune/ IBD type cause and not the medications, which the FDA now finally acknowledges can cause disability due to the severity and long term nature of side effects. Based on anecdotal reports, it seems most doctors do not seem to recognise these side effects and they extend way beyond Achilles pain...

The fact is, that even extremely healthy people are taking even very short courses of these drugs for minor issues all over the world and many are reporting becoming partially or completely disabled. There are tens of thousands of them online supporting each other on various sites, if you look up on google or Facebook ' flouroquinolone toxicity' you will find them.  

Here are some links for your interest. Plenty of peer reviewed studies in the floxie hope link.

http://www.fda.gov/Drugs/DrugSafety/ucm500143.htm

https://floxiehope.com/fluoroq...nes-links-resources/

https://www.amazon.com/gp/aw/d...WOtyL&ref=plSrch

http://www.medicationsense.com...Qreactions042011.php

http://www.medicationsense.com...cles/2014/letter.php

myquinstory 

Please feel free to get in touch, would be happy to connect with you.

best of luck recovering and getting on top of pouch issues, agree rifaximin may be good and a lot safer. All quinolones, flouroquinolones you may want to steer clear of the whole classes of them to be on safe side

bestvwishes 

Last edited by claire

I alternated Xifaxan and Augmenten for 8 months straight and they didn't work. I can't take Cipro because, like you, it caused c.diff when I had my colon. I had it also in my j-pouch and was told never to take cipro again. I had to go off Flagyl because it made my perpherial neuropathy worse.  I also took Augmenten pretty steady before going to 100% on antibiotics.

I now have an ileostomy and my j-pouch was removed. So mine is not a success story. I feel much better without my j-pouch.  The ileo is better than my awful temp iLeo was. That said my j-pouch got sick within the first year and it was removed 5+ years after it was created. You had a healthy one for a long time. It would be great if you could get back to a healthy one so hopefully our suggestions help.

Last edited by TE Marie

I currently have had pouchitis since mid-Sept. It is the first time I have had it and I have had my j-pouch for 5 years. My doctor is treating it with tetracycline 500 mg 2xs daily and Entergam food supplement medicine and VSL 3. I am also on the Low-FODMAP diet. I feel these things are helping and I am improving. I have adverse reactions to Cipro and am allergic to Flaggl, so we had to go a different route. Best of luck to you!

Last edited by JenB

 Thank you everyone again for your responses and support. I have an appointment to go to see Dr. Shen  at the Cleveland clinic on February 7. I am hopeful that he doesn't react dismissively to my theory that all of this musculoskeletal pain is related to Cipro. 

 Claire, thank you so much for sharing the links. I have done a lot of reading but some of these are new to me. 

 So far three days on Augmentin has done nothing for my pouchitis. Sadly, I know that I have responded in the past very quickly to Cipro but since that is no longer an option, I will have to give this a longer try. If it still doesn't help after a week, I will go to the more expensive option and try Xifaxan.

thank you again everyone.

All the best Tracy... it's a bad thing to go through and a lot of us have been there.  I hope you get relief soon.  

JenB, please let us know how your treatment progresses.  A lot of us are looking for other options to cipro/flagyl... especially if it results in less meds and more of a natural treatment.  All the best.

Mark

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