I agree with Scott’s post above but once it is proven that you can handle both cipro and flagyl, using them in tandem as a shotgun treatment for one off Pouchitis episodes is most effective because it covers the broadest range of bacteria and insures the most effective result. However, if you are new to these antibiotics they should be taken one at a time until it’s proven that you can handle them.

herb ear posted:

Thank you, how about cipro & xifaxan combo?

I would never take xifaxin in combination with any antibiotic for the reason that it’s not systemically absorbed and if you have to take antibiotics chronically it’s something that gives your system a breather from the other systemically absorbed antibiotics.

Back in the 1990s flagyl always would get prescribed first and cipro second. My GI from 1992 to 2009 was the go to GI for many  Mount Sinai J Pouch patients in NYC including myself. He noted that in patients who could handle both flagyl and cipro without significant side effects, that using the two drugs in tandem, as a “cocktail”, produced much better results than used alone. The reason why is they are different antibiotic families and work on different bacteria groups that cause Pouchitis, both of which are present in many Pouchitis cases.

He encouraged me to try the “cocktail” when I became chronic and it worked much better than either antibiotic taken alone. 

He also cautioned me to never use cipro with levacquin (same family of antibiotics, so it’s like incest among antibiotics to use them together). He suggested I go from cipro and flagyl to xifaxin or some other antibiotic when I rotated and not right to levacquin. Levacquin can also be used with flagyl. 

If you have to take antibiotics chronically it’s important to understand how they work and on what bacteria, and your body’s reaction to each of them, and from there you can develop a plan.

I always thought of Cipro and Flagyl like Gin and Tonic, or Batman and Robin, or Simon and Garfunkel- just a famous duo that worked well together.

herb ear posted:

What are the chances of getting c-diff while on antibiotics?

You are unlikely to get C. diff while on Flagyl. You can definitely get it while on Cipro, but only if you are exposed to it (like any other infection). I was on Cipro alone for about 6 years and never developed it.

herb ear posted:

 I am curious how your liver is able to process these drugs...


You would have to ask my liver that question, but it’s also processing Remicade and Methotrexate for the past 4 years and I regularly have blood labs done to check my liver chemistries which only got out of whack when I was on a higher dosage of Methotrexate than I am now. Because my body has not developed antibodies against Remicade, my GI has said he will likely take me off of Methotrexate altogether. I am taking very low dosages of antibiotics now, like 250 mg per day and no longer taking cipro and flagyl together.

25 years ago I asked my GI the same question as you are asking about whether the liver can process antibiotics used over the long term. His answer was, “you are the guinea pig” in that study. I don’t know if there have been any studies on it since.

I never had c diff.

Because antibiotics alone were not working as well as they needed to after 25 years and my J Pouch inlet was becoming strictured, which is a common situation with long term Pouchitis patients. I was taking antibiotics exclusively for a very long time before introducing other treatments. 20 plus years

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