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I have had a good streak of health for near 10 years and now have ran into a bout of pouchitis (maybe the move from FL to MN? ). I normally have responded well to using Flagyl by its self but this time it did not impact anything. I then went and had a scope w/ they said I had moderate to severe pouchitis and put me on Cipro for 2 wks. some things improved but still had more than normal nightly trips to bathroom and also leaking while asleep. After the cycle ended things started to get worse 3 days later. Gas that seemed to flow through small intestine to the bottom of my pouch/bottom (painful to try and manage it w/o feeling an explosion out my bottom). I contacted my doctor and they said they would start up another round of Cipro for 3 weeks (same mg amount).

it has been 3 days and the painful nighttime gas train is starting up again. Should I be requesting another antibiotic to run w/ Cipro? My original doctor in AL who preformed the surgery would put me on Levoquin and Flagyl.I have never been on Cipro till now. any input would be appreciated. I am starting to second guess the care I am getting and considering going to the Mayo Clinic. 

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Metronidazole (Flagyl), unlike ciprofloxacin (Cipro), is very poorly absorbed into systemic circulation, therefore its concentration remains very high in the GI tract where we actually need it.  In my experience, if 5-7 days of Flagyl does not resolve the problem, it's likely not bacterial and quite probably mechanical, i.e. not getting fully empty due to stricture, for which dilation is advised.  I've never had to mess with Cipro for pouchitis, though I've used it for wound and sinus infections. 

I'm 30 years into my pouch subsequent to total colectomy 2* intractable UC and generally Flagyl takes care of my 2-3/year pouchitis within several days.  I've never needed more than a week's worth, save for month-one after takedown when I was slowly tapered off the Flagyl as the pouch tissues adapted to the increasing microbial count.  Note, this was not due to early pouchitis, but simply my surgeon's standard post-op protocol, which probably should be more widely adopted than it apparently is.

No, I’ve never tried probiotics beyond eating low sugar yoghurt most every day.  The live cultures in yogurt are actually among the main strains you’ll find in a lot of the supplements, so maybe that’s something. 
Science has just begun to interrogate interrelationship between the gut microbiolota, mucosa, and immune system with a long way to go.  But I can guarantee that many interesting and important data will come from that work. 
Bo Shen, MD, now at Columbia, has done some of the cutting edge research in that field with respect to both IBD and pouchitis. 
Hope you round the bend soon!

So was off all antibiotics for 5 days and felt pretty good. Sunday came along and seems I am back at ground zero. I have an appointment tomorrow and think I will request to go back on Flagyl and Cipro together for 2 weeks vs flagyl for only one week. Is this the best course of action? I am willing to give this another round to see if it will knock it out. 

Last edited by Furious Pouch

It’s worth a shot. Your odds might improve if you add a substantial/maximal probiotic dose, continuing that after you finish the antibiotic course.

You could be experiencing a difficult-but-controllable bout of acute pouchitis, or possibly the development of chronic pouchitis. The best way to tell these apart is to make sure you’ve thoroughly treated the acute condition, and minimized the chances of a recurrence. That’s why it may be worth shelling out for plenty of probiotics (Visbiome or VSL #3).

You are taking a very small dose, which is probably why it might seem affordable. My dose (of VSL #3, which is packaged the same ways as Visbiome) is equivalent to something like 32 capsules per day. I just mix two extra strength packets into yogurt twice a day, before breakfast and dinner. My insurance covers the prescription strength, but it took a year-long fight to get them to do so.

If you can afford to do so I’d suggest throwing a lot more Visbiome at this, at least temporarily. You’ve already had a treatment failure, so giving your system its best shot at normalizing is probably worth it. Some have argued that it’s a waste to take probiotics while on antibiotics, but they don’t really know that to be true. In my personal experience it’s quite helpful, at least at high doses or probiotics.

need some advice again if possible. went on 2 week cycle of Flagyl /cipro and while on it everything was good. I could eat when I wanted, ride my bike, etc. One day after I stopped taking it I got the flu. All pouchitis symptoms came back. I called the doctor and the next course of action from his plan was Mesalamine. I have been taking this for 4 days now and it seems the pouchitis symptoms are even worse. Painful gas feeling that makes you need to run to the bathroom, slimy stool, lack of appetite.I am not eating much at all to try and avoid trips to the bathroom. I am just not sure if I should give this more time or call my doctor to see what the next options are. anyone have success with Mesalamine for pouchitis? is there a sweet spot of time that I should be targeting (one week, 10 days)? it is hard to want to try anything new especially since this was over $300. 

Mesalamine isn’t usually used to treat pouchitis, but it’s common for cuffitis. Your doc might be considering the possibility that you have/had both, and trying mesalamine to reduce the possibility of multiple conditions confusing things. Mesalamine doesn’t work very fast, though, so it’s less satisfying than antibiotics. It certainly takes longer than four days to work, when it works at all. And you might not have cuffitis. 

The flu makes everything trickier, since many of us have pouches that behave poorly when we are sick in other ways. You might just have a pouch that’s pissed off about the flu.

when on both antibiotics I was good. My current doctor is concerned about long term use and also the possible side effects of Cipro. I see ppl on this site who use both of these drugs as a daily regiment. Another doctor in the same office was willing to consider Cipro as a long term option. Would you suggest 2 weeks or 3 weeks on these again and see? I am worried that if I continue on this path of being on Mesalamine I will weaken more (hard to eat, loosing wght, depressed). While on this drug I seem to have gotten way worse than any Pouchitis I have had. 

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