It’s always up to you. Do you know how inflamed your pouch is (or isn’t)? If you have significant unmanaged inflammation you can develop complications (e.g. strictures) beyond whatever pouchitis symptoms you have. Nevertheless, most folks do okay treating pouchitis when they have unpleasant symptoms. Antibiotic “dependent” pouchitis isn’t caused by antibiotic use, but rather inflammation that just won’t stay away without constant treatment.

In my recent  scope my dr said that I had inflammation.  Other than that, how much idk.  Not sure what to do with that info.  He seemed to be debating next step but ultimately didn’t offer any other suggestions so That was the end of it I guess until next time.  

That’s interesting Leeloo.

my GI said on my recent scope that my pouch showed mild inflammation and called it mild pouchitis. Since I have no symptoms neither of us dwelled on it and only this thread reminded me of the diagnosis.

What symptoms do you have @Leeloo?  Do you get frequency, leaking, tenesmus (that feeling you need to go but don't), pain or something else?  For me, these are symptoms that antibiotics help address, and I'll stay on a low dose of antibiotics if it means I can go weeks at a time eating fairly normally and not thinking much about my digestive tract.  

AMB,  frequency comes & goes but nbd.  I’m used to it and it has calmed way down since post menopause.  Occasionally a feeling like things are getting twisted up in there which can lead to the occasional blockage.  This is rare and hasn’t happened lately.   And this lead me to ask the question because the last time I felt like either something was getting twisted up that felt like it could be on the way to a hospital trip for a blockage, I took the antibiotics and low and behold, that was the end of it.  Which led me to question if I should be taking these things more frequently, and before it gets to that point.  Or maybe it was just a coincidence and it would’ve resolved itself either way.  I may never know.  🤔

I don't think there's generally any connection between antibiotic use and blockages. Antibiotics mostly address pouch inflammation, and blockages are usually a mechanical problem upstream from the pouch. Because blockages clear up on their own most of the time it can be tempting to associate the improvement with whatever you were doing just before it cleared up. Sometimes the connection may even be real, which seems like it might be the case for the barium swallowed to image the small bowel, but most of the time it's coincidence.

New577- that’s good, better to not focus on health stuff too much when you’re feeling good! 😄

Thanks, Scott F for your helpful insight!  🙂

Some people can tell by the smell of their BM whether they are having pouchitis or not, I notice only if I have let it get to far.

If I feel gassy for more than a couple days I'm probably going to start antibiotics, usually in about 3 days I can tell if it's making a difference.

It's hard to figure out what to do and I get the concern for getting stuck on antibiotics or becoming resistant but letting the pouchitis run rampant can't be good either.

I hope this helps a bit and good luck!

Thanks pouchlogic.  If after the 3 days it’s not making a difference, do you then stop taking the antibiotics? How long do you generally  take the antibiotics?

I don't stop after 3 days, I'd probably try for a 2 week minimum and I usually stay on for 1 months. I have been able to only go on antibiotics for 2 weeks and have it resolved but sometimes it's not long enough and I end up on them again.

The several times my GI put me on Cipro were always for a minimum of 14 days.

Most people seem to get noticeable symptom improvement after a few days, particularly with Cipro. If I were getting no benefit after 7 or 8 days I might put in a call to my doctor to discuss trying a different antibiotic. A single antibiotic not working doesn’t tell you much - it can still be pouchitis, and a different antibiotic or combination might work fine.