Empiric treatment, abx duration | The J-Pouch Group

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Pouch2021

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Hi All,

My surgeon recently prescribed cipro+flagyl for 14 days and I must admit that I’m feeling better after 5 days other than now having some constipation. Actually the urgency improved after only 2-3 days. I just had my take down 4 weeks ago so figuring out what was normal vs pathological was difficult but I was miserable so he threw 2 abx at me at once (probably overkill and should have started with one or the other) BUT my symptoms improved within 3 days. Will have a scope in next week or 2. I also have PSC so at increased pouchitis risk. Just didn’t think it would happen so soon.

Question is can I get away with a shorter course of abx? Part of me wants to stop now (after 5 days) and see how I feel. I’ll have a scope very soon so the worst that could happen would be a return of symptoms and maybe a definitive diagnosis of pouchitis when he scopes. As it is now, I may never know as he treated empirically and the inflammation may be gone by the time he scopes. 14 days of cipro/flagyl seems like overkill since symptoms are much improved. Thoughts?

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Scott FMember

I'd take the full 14-day course. The best thing to do with acute pouchitis is get rid of it and look at it through the rear view mirror, and not create a scenario in which you can't tell inadequately treated acute pouchitis from chronic pouchitis.

Former Member

I am sorry you are going through this. Definitely continue treatment, at least if that does not work, at least you can try biologics.

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