If I were at that point I'd try a couple of things:
1) Max dose probiotics (I already do this)
2) Dietary changes (some folks get good results with very low carb, and others are using FODMAP). This is difficult, but I bet you'd do it in a heartbeat if you knew for sure it would work.
3) If all else fails, consider FMT (fecal transplant)
4) Perhaps a very different antibiotic, like Xifaxan ($$$$)

I don't think adding a 3rd into the mix is your best option. Likely, you need to step away from the ones you are on right now and try something else. The longer you are on them, the less effective they will be. You can try the Flagyl, but I would take it alone. As Scott said, I would try to make some diet changes and increase probiotics. I also really like Pepto Bismol so try that if you haven't yet. I've also had great results stepping back from the antibiotics and taking a 7-10 day methylprednisolone pack. Good luck getting ths under control.

Cipro and flagyl are used in tandem because they are in different antibiotic families and go to work on different bacteria. The advantage of using them in tandem is that they have the "shotgun effect" of killing a larger swath of bacteria. The disadvantage is that if you experience side effects, you may not know which one is causing them, and will be forced to isolate. These basic rules apply to any antibiotics used in tandem.

I think Scott's advice of maxing the dosage and making dietary changes is the most sage advice. Cutting out sugar and carbs could help. In my case when I cut out sugar and carbs and implemented portion control I was able to cut down on antibiotics consumed SUBSTANTIALLY. I now rotate different antibiotics every other week with lactulose. This was my GI's idea and along with the dietary changes, it has worked.

I take cipro in tandem with flagyl and it works much better than the same dosages of either in isolation, for reasons stated above. However I tolerate both antibiotics well, even in high dosages. I have not yet taken an antibiotic that caused intolerable side effects. The side effects I have experienced are photosensitivity to sunlight (cipro) and exposure to fungal and viral skin infections (cipro/flagyl for too long a period of time without a rotation or break).

Thank you for your quick responses! I haven't tried flagyl alone in a while, because it never seemed to have helped, but I can try that with PB, has anyone had problems with that combination? Ideally I would like to go back to the cipro, but I guess it might help to take a break from it. I have adjusted the diet and now I would give almost anything to be able to sleep through the night, it's so draining! Is it just me, but do you notice the pouch flares in the beginning of Fall and maybe with every season change?

Has anyone taken Aspirin for pouchitis and if so, has it helped? Is it in the same family as advil?

My understanding is Pepto Bismol should be taken in between antibiotic dosages and not within 2 hours of taking antibiotics, or it will interfere with the absorption and/or action of the drug. I think there are also warnings to that effect, to not take PB within 2 hours of taking any prescription or other pills or vitamins.

Doesn't lactulose cause increased bms?

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Doesn't lactulose cause increased bms?

Yes it does but you can counteract the runniness caused by lactulose very effectively with imodium. Lactulose is a prebiotic and helps get your good bacteria count to where it needs to be.

Quick update....I've started the flagyl on it's own today, but might need to take something with it, like PB or immodium, but won't this decrease the effect of the flagyl? And as for diet, wouldn't a bland diet help, like rice, breads and soups, etc...?

Immodium shouldn't interact with Flagyl. PB is probably best spaced a couple of hours apart from other meds. A bland diet might help or it might have no effect at all. There's no harm in trying it, if that has served you well in the past, or if you just want to give it a try.

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And as for diet, wouldn't a bland diet help, like rice, breads and soups, etc...?

Rice and bread are horrible because they are loaded with carbs which creates a bacterial feeding frenzy in your bowels. Pouchitis in many cases is due to bacterial overgrowth. "Bland" does not necessarily mean good if your sugar and carb intake is high. If you want bread eat something made with nut flour. As far as white flour goes, it is poison and you should throw it out, if you have pouchitis/SIBO.

Do not make the same mistake that other posters make in thinking that if it digests well, then it must be good for your pouchitis. This analysis is short term only and is probably the opposite of what you should be doing long term. Rice and bread may digest well but they are also going to cause SIBO and make the pouchitis worse in the long term.

As I already mentioned PB can be taken between antibiotic dosages spaced at least 2 hours apart. Not sure why you would take imodium unless the flagyl is not slowing down your rate of BMs, which normally it does. PB and flagyl should slow down your BMs considerably and if they don't, they aren't working.

Most folks with J-pouches don't have SIBO, and do just fine with carbs. Nevertheless, it's true that someone with pouchitis may often get better results with a low carb diet than a bland diet, but a low carb diet is much harder to sustain. It is likely true that white flour works poorly in some people's bodies, but I think it's an overstatement to call it "poison." If people try what they can reasonably manage and pay attention to the results, they're likely to find their way.

White flour is right at the top of the list as far as foods to eliminate on the FODMAP diet. My GI has told me that my problem is SIBO and the SIBO is what is causing the pouchitis. People who say they can't sustain a low carb diet don't want to get better. I have sustained a no carb diet for almost a year now. Ask poster Vanessavy - it may take a year to reduce SIBO appreciably so if you are not in it for the long term, you are not in it at all. Everything I am saying here Dr. Shen and his disciples are and have been saying for some time now.