Hi All, 

I am experiencing a bout of pouchitis.  I don't get it often.  May be once or twice a year, typically when I'm stressed & eating lots of junk (ie: the holidays).  I believe it started mid November & I did start a round of Flagyl in early December.  500 MG 3 times a day.  It makes me  nauseous, gives me horrible cramps & I can barely tolerate the constant taste of metal in my mouth.  Because of these side effects, although I know better, I cut my treatment short after probably only 5 days (I forget).  I was supposewd to be on 3 pills (500 MG each) for 10 days.  Low & behold, it's back w/ a vengeance & I know how important it is for me to adhere to the treatment but Flagyl is causing nausea, cramping & metal mouth again.  I skipped a pill last night because I couldn't take it. I know 2 a day is another treatment option & one that I can tolerate much better than 3. My question for all of you is, what dose of Flagyl does your doc prescribe?  1000 MG a day, 1500 MG a day, ??


Thanks in advance for your replies,



Original Post


Thanks for quick reply.  The last doc I saw, last week, told me she doesn't like Cipro.Didn't want to prescrib it. I asked for it because I knew Flagyl & I don't get on too well!  I feel like 500 MG 3x day is overkill. I've seen 500 MG 2ce a day for 2 weeks cited online. If that works, I'd much rather that protocol.  I'm going to call my doc & if need be, continue on high dose 3x day.  I'm more than 1/2 way done at this point.


Best regards,



Unfortunately that doc is an idiot. It’s certainly true that Cipro can sometimes have terrible side effects. So can Flagyl. Every medication includes a risk/benefit calculation. Casually choosing a poorly-tolerated medication based on sloppy risk estimation isn’t good medicine.

It’s true that Cipro shouldn’t be the first choice when equally effective, safer alternatives exist (for example to treat a simple UTI). That logic does not apply to your situation.

Cipro does have some potential side effects that are unpleasant, but the doctor should explain what those side effects are and let the patient decide whether or not to assume those risks. It’s not for the doctor to decide unilaterally not to prescribe a medicine that is of potential benefit to the patient. I agree with Scott that the Doc is idiotic.

Regarding dosages, with a bad flare of Pouchitis or Pouch inflammation, my GIs usually prescribed a high dose and told me to adjust downward after the symptoms were ameliorated, to the lowest dose at which symptoms seemed well tolerated or controlled. It’s all trial and error on an individual basis, there are no industry standards on this kind of thing.


I agree with what has already been stated.  Not everyone can tolerate Flagyl and your doctor should work with you to provide medicine that will work for you and not make you feel worse than you already do with pouchitis.  I too can't handle the nausea with Flagyl.  Currently, I'm using  Levofloxacin and take one a day for two weeks.  (Done tomorrow, yeah!) It usually works to tame pouchitis down and allow me to get back to better habits to avoid it in the future. Just like every medicine out there this one has side effects, (like causing nightmares), but these I can cope with.

Good luck on getting the help you need!

For chronic pouchitis requiring long-term antibiotic therapy it’s pretty straightforward to find the lowest effective dose, as CT describes. This doesn’t work as well with acute pouchitis, since lowering the dose too much can prolong the treatment and increase the likelihood of resistant organisms flourishing. You really don’t want symptoms redeveloping in the middle of a 10-14 day course of treatment. It’s not an exact science, but it can be guided by whatever worked (and was well tolerated) the previous time.

The maximum amount of Flagyl taken for pouchitis, according to a paper, is, 20 mg/Kg/day; this means that if your weight is 75kg or 165pds, you can take up to 1500mg, which means 6 tablets; in that case you could take them three times / day (2+2+2). I always took no more than 3 tables (750mg) anyway.

Thank you all for your replies.  I finished my Flagyl dosage up yesterday. I am soooo happy to be done with it.  I'm keeping my fingers crossed that it did the trick.  if not, I'm going to a new doctor & asking for Cipro.  I can't face more Flagyl anytime soon.


Warm regards,


Jami1989 posted:

Antibiotics kill the good stuff we need to which can create more problems.

They also kill the bad stuff that causes all the problems. If you think that probiotics are a panacea that will solve IBD on their own, good luck. That doesn’t fly in most cases. Taking antibiotics with probiotics is often a waste of money because the antibiotic may kill the probiotic or reduce its count. My GIs in the past were against probiotics as a method of effective treatment of IBD as opposed to a dietary supplement, and the two objectives should not be confused with one another.

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