There’s not really anything in the “Flagyl family,” but you can look at others. First, have you experimented with a lower dose of Flagyl? Many side effects disappear when doses are lowered, and sometimes the efficacy stays the same.  A good probiotic, like Visbiome, might reduce the pouchitis frequency and the dose needed to manage it.

It’s also worth trying an antibiotic alone before deciding you have to combine it with another one. I take Cipro and Flagyl together, but first I made sure that neither one worked alone. 

A good one to try would be Xifaxan, which has an excellent side effect profile but costs a fortune when dosed adequately. Augmentin is also worth a try, as is Tindamax. 

In what way is the Levaquin alone proving inadequate? Does it take longer than you like to work? Is it failing to clear up the pouchitis reliably?

Dr. Shen gave me tindamax as an alternative to flagyl.  It worked well, without side effects, for awhile, but eventually similar side effects occurred.  I was on it for nearly a year.

Scott: Good points.  I believe I've tried Levaquin alone and Flagyl alone, and neither one knocked out pouchitis.  However, it is possible that Levaquin alone may have helped.  I usually see results within 24 hours of my first antibiotic.  I usually do ok with Flagyl/Levaquin when it is just basic pouchitis, but this time around after my nose surgery, I just think I was more beaten down physically and mentally.  As long as the pouchitis does not get out of control and I get it early on, the Flagyl/Levaquin seems to work.  I'd just like to be able to not have the issues that I have with Flagyl.  However, I'll take some discomfort over pouchitis any day.

Cipro is a good alternative to Flagyl. I rotate Levo and Xifaxan. I also had to stop one or both for a short time (can’t remember the reason) and they subbed in augmentin which also worked well for me.

Ciprofloxacin helped me a lot this spring, so my doctor has me on a rotation of 2 weeks of ciprofloxacin and 2 weeks of vancomycin. He says vancomycin is a good choice because almost all of it stays in the digestive tract. It hasn’t worked nearly as well as ciprofloxacin for me, but it’s still much better than nothing. 

I am using cipro and flagyl after 3rd time with pouchitis and this time the pouchitits came back a few days after taking both for 2-3 weeks. I’m going back my doctor today to suggest i go on it again but perhaps take some of these alternatives to suggest to him because i think flagyl is affecting my appetite and mood?  anyone have any suggestions for least amount of side effects?  The doctors in Australia say they don’t see a lot of pouches as they really don’t perform this surgery downunder.

I haven't had any side effects from cipro or vancomycin. In the past, I haven't done well with metronidazole (flagyl) - nausea, dizziness, lack of appetite.

many thanks for the reply. I read that vancoycin can be a risk since I’ve had thrombophletitis 2x however many years ago while taking high steroids for UC but i might want to consider that they list this side effect on WebMD for it:

Common adverse drug reactions (≥1% of patients) associated with IV vancomycin include: local pain, which may be severe, and thrombophlebitis.

Indiana, the side effects you listed would only occur with intravenous vancomycin, not with capsules.

Ok, thanks for clarifying that is good to know. Right now it’s limited coverage as I’m on the PBS in Australia but they will cover cipro (but only if others don’t work as they want to limit it as a golden drug if they find they need it for antibiotic restistant strains).  I did go back on a lower level flagyl 200mg x3 day vs the 4x a day since a 2week combo of cipro and flagyl only slowed the “itis” down and didn’t clear it. If this doesn’t work I might suggest Xifaxan as they do cover that here and I’ve heard it’s effective with less side effects? I’ll check on vanomycin to see also. Thanks again for your comment mate!

I use Erythromicin(sorry spell)...no side effects...I would stay away from Cipro!!!Lots of literature confirming very bad side effects....I became very anxious while driving after many years on it...went away when I stopped.

On Entyvio now...biologics may be the way...we will see

Thanks JBaru for this reply. I am off the CIPRO now for a few weeks and so far so good. I’m supplementing with probiotics and using wild oregano oil as well to see if I can stave off the bad bugs from coming back. I used to take erytho as it was prescribed at that time for acne so it may not be as effective on me as I was on it for a long time.  Again no side effects except sun sensitivity.

I know what you mean with the CIPRO anxiety I was anxious on it as well and had a hard time sleeping on it, not a good drug long term I’m afraid but does the erytho work quickly for the containing the Pouchitis?

cheers mate