If you are truly antibiotic dependent, it is better to stay on them full time, especially if you intend to use low doses. Otherwise, opportunistic bacteria are more likely to run amok during the "off" weeks. If resistance develops, or to prevent it, you can rotate antibiotics every couple of weeks.

Here is a good article that talks about this sort of therapy:

http://www.medscape.com/viewarticle/736822_4

Jan

I have 11 days left on my 30 days of cipro , I am going to call my doc and see if I should taper off them instead of going off cold turkey after being on them for 20 days so far.

Also, if you are not already taking them, overlapping probiotics before you stop the antibiotics may be a good strategy. That way, they have a chance to colonize before the antibiotic is done. Probiotics can take 3 months to show a full effect. While they may not be useful for treating pouchitis, they can be helpful in preventing relapse. However, if you are a stubborn case of antibiotic dependent pouchitis, they may not be as useful (according to a meta-analysis of various studies).

Jan

I take a packet of vsl#3DS every day.

Thanks, Jan. I've decided to go back on abxs, rotating low dose tindamax/augmentim. I'm hoping this will get the fistula drainage (infection) back under control, with the added bonus of a better-behaving pouch.

I've done a little more research, and it seems like - when I can find anything at all - there are just conflicting opinions on the treatment of fistulas with long term antibiotics.

Holly - although my gastro told me I could go cold turkey off the antibiotics, I did wean myself off. I've also taken probiotics forever, which I feel helps. Good luck!

My thinking is that when you have IBD and a fistula, you have two things going on. And, if antibiotics help treat the IBD, then you go with that first, since the IBD can be the thing helping perpetuate the fistula.

Have you considered Remicade or Humira to help heal this, or at least keep the symptoms minimized? Others have gotten their R/V fistulas to the manageable point this way, and avoided long term antibiotics. But, rotating antibiotics is a good strategy too.

http://www.mayoclinic.com/heal...treatments-and-drugs

Jan

Thanks Jan - seems as though Dr. Hull (Cleve. Clinic CR surgeon) thinks that anything other than major surgery (pouch re-do or pouch removal) will take care of this fistula - and even those options do not provide a guarantee, according to the surgeon. Neither she nor Dr. Shen ever suggested Remicade or Humira, which is rather interesting.

I'm back on tindamax and things have improved already. Until I see my surgeon again, I'll continue with as low a dose as will help with the symptoms. I will ask about humira - from what I've read, however, it seems that it and remicade typically works temporarily - in most cases. Just not any real, permanent, safe, easy, painless (ha ha I'm on a roll here) options with this fistula. Seriously, it can get a person down.