quote:

Metronidazol

Also known as flagyl, and cipro, are the two most commonly prescribed antibiotics for pouchitis, if that is what you are experiencing. Both will leave you prone to yeast infections, although my personal experience has been that I only got yeast infections when I took one or the other for too long and did not rotate onto other antibiotics.

Xifaxin, augmentin, keflex, and other antibiotics can be used to treat antibiotics but cipro and flagyl are the top 2.

Not sure why you do not want to take cipro or think it will "make matters worse." It is THE single most effective antibiotic I have taken for combatting pouchitis. You may make matters worse by not taking it, if in fact your issue is pouchitis.

Probiotics, alone, are not likely to be effective in treating active and flaring pouchitis.

I agree with CTBarister. I fought taking cipro for a long time and took augmentin instead. It was not until I started cipro that I saw a real difference in my pouch function and like Ct, some of us are on it long term for chronic pouchitis.

Pouchitis is easier to treat if you attack it early on. You do not want it to fester and possibly get where it cannot be easily managed.

Thank you guys, I really appreciate your replies.

The reason for me questioning cipro is, because I am quite sure, that it was the previous antibiotic, metronidazol, that messed my pouch up.
So in my mind it is hard to find the logic in taking yet another antibiotic to combat what the first one seems to have caused, get me? And since one of the most common sideeffects of all antibiotics is diarrhea... well, that's part of what's wrong right now.

During the day I have decided to let the hospital run test of my "deliveries" first, just to outrule other reasons, before I take more drugs. It will only take a few days, so I'll have to live with going to the lue every hour doing nighttime a few more days.

Cipro and flagyl are totally different antibiotics, they are not the same or in the same family and they work on different bacteria. Flagyl is a a nitroimidazole antibiotic http://en.wikipedia.org/wiki/Metronidazole while cipro is a fluoroquinolone antibiotic http://en.wikipedia.org/wiki/Ciprofloxacin.

They are often prescribed in tandem because they attack different bacteria- thus the two in tandem create a "shotgun effect" in killing a larger swath of bacteria. The larger amount of bacteria killed creates the condition that potentially exposes you to possible yeast infections, which you need to be proactive in preventing if taking these antibiotics.

Cipro and flagyl, if they are working and they are tolerated, usually cause a thickening of the stool, rather than diarrhea. In your case, the flagyl may not have worked or may have caused the side effects you are experiencing, but just because you did not tolerate one antibiotic is not really a sound reason to throw all the other ones away.

Maybe I'm missing something here, but I don't see how an antibiotic is supposed to help a yeast infection...it's yeast so you need an antifungal. I don't seem to get them much anymore, but I would frequently get mild yeast infections when starting/rotating to a new antibiotic. Usually just one day using Monistat would clear up my symptoms. Then I'd continue using it for a couple more days. I would highly suggest using that first if all you are trying to do is treat a yeast infection. But, if you are having pouchitis sypmptoms and the Flagyl isn't cutting it, then yes, I would try the Cipro. It works much better for me with a lot less side effects.

clz81,

I can see why you were confused by the original post but when Lovelife mentioned "infection" I did not think she was talking about a yeast infection, but rather pouchitis. Perhaps Lovelife can clarify this. If she was talking about a yeast infection then I agree with the post of clz81. Yeast infections are treated with antifungals, not antibiotics. However antibiotic use leaves one susceptible to yeast infections. As mentioned previously, rotating antibiotics at regular intervals should prevent this from happening. I keep the areas of my body most susceptible to yeast infections (armpits, legpits and groin area) copiously dry by blow drying them after I shower. I have actually seen yeast infections start in my armpit and I stamped them out by blow drying the area, using a dry deodorant and applying Zeabsorb-AF powder at bedtime.

Sorry for the confusion.

My doctor thought I had a bladderinfection, then prescribed antibiotics that resulted in yeastinfection and possible also in my problems with the pouch. In the end my abdominal doctor wanted to treat my pouch-problem with cipro, which I ended up not taking. Instead I began with probiotics.

After about 10 or so days, my pouchproblems almost dissapeared, though it has feelt like it re-set my pouch, so now it works like just after the operation meaning, that I have to go many more times than just a month ago.

The worst is the nights. Before I just went 1 time a night, now it is 3-4 times, and I don't know what to do. I wake up when I am leaking just a bit, but still, I am leaking!!!
That very rarely happend before, and I am desperate to figure out how to stop it. I am following the general advice about food etc, but so far no luck.

Hope this clarifies things

LoveLife, unfortunately it sounds like you still have pouchitis. There are people who functionally have leaking issues and it can be normal, but having to go that many times at night with leaking is my #1 sign of pouchitis. Whenever I get to that point, I know I need to rotate meds or get back on my meds. In your case, since you never leaked before nor had to get up to go to the bathroom, I would think the pouchitis is definitely still there.

I would agree with clz81. I would also add probiotics is very unlikely to make the problem go away once you have it- it may help keep you in remission if you can get into remission but it does not sound like you are there yet.

I am not sure why you did not follow what sounds like prudent medical advice from your Doctor by refusing to take the most effective antibiotic for treating pouchitis (and that does sound like what you have). The situation is likely to deteriorate and get worse if left untreated.

I am on cipro again and think it has lost it's effect. Doc's office said they can call in flagyl next, guess I will call them on Monday and hope that helps.

I tried using VSL #3 probiotics and they ended up making me much worse off...probiotics work differently for everybody, it seems. Be careful with those. It is possible to use probiotics in conjunction with antibiotics, contrary to what one would assume, but it doesn't need to be a very powerful probiotic.

I'm currently trying to build a list of antibiotics that people have used to treat their pouchitis flare ups, and so far I have:

1. Tetracycline (no longer available, worldwide shortage)
2. Cipro (really strong but okay for longer term usage)
3. Flagyl (super strong but can have some side effects like you describe, and not healthy for long-term usage)
4. Xifaxin (which can be fairly expensive, up to $350 a bottle uninsured, but it is very effective from what I hear)
5. Amoxicillin (Augmentin) (this is the best lower-powered AB I've used since Tetracycline, very effective for my own needs, have you tried it for maintenance?)
6. Keflex (this can work, while it did work for me by fixing the pouchitis infection, it produced a cuffitis reaction that made life miserable, so be careful there)

Here's a neat article talking about some other possibilities (including budesonide enemas and immunosuppressants): How Do You Treat Pouchitis?

There are a lot of combinations that can go on, including steroids, but nobody wants that. My own doctor put it in this order: Probiotics, Antibiotics, Steroids, Surgery. I see steroids as a cliff I don't want to even approach, much less jump off, but if I have to, so be it.

Everybody here in the forum is so helpful, I'm sure you'll continue to find more suggestions as time goes on. Hang in there!

quote:

Flagyl (super strong but can have some side effects like you describe, and not healthy for long-term usage)

Not sure what you mean exactly as I have taken it for 18 years to treat pouchitis in rotation with other antibiotics. I have no side effects from it so when you mention long term issues being caused I am curious what you mean exactly.

I guess this is what I've been warned about, long term use of Flagyl can cause leukopenia (decrease of white blood cells, increased risk of infection), neutropenia (increased susceptibility to bacterial infections), increased risk of peripheral neuropathy and / or CNS toxicity, it's also listed in the US National Toxicology Program as reasonably anticipated to be a human carcinogen.

I realize that everything has its cost, but for me Flagyl is something to use as a 'nuclear' bomb when all else fails. I guess I should make it clear I'm not a doctor (not many on this forum are, it's mostly our own experience), I'm just providing my own insights and experiences. Obviously everybody has their own body interactions, sounds like you and Flagyl are getting along great. I hope that if the time comes for me to go full time on it I have the same reaction.

CT what other antibiotics do you rotate out for the Flagyl? I'm currently trying to find a roster, right now I've only been able to tolerate Flagyl, Cipro and Augmentin, and would like to use the Flagyl and Cipro sparingly. Do you use other ABs other than those? I'd appreciate any input on this. :-)

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CT what other antibiotics do you rotate out for the Flagyl?

cipro, augmentin, and xifaxin. I have also used keflex and some others but my top 4 are cipro and flagyl, xifaxin and augmentin.

Thanks CT! I'm glad to know that people can be on Flagyl for a long period of time and not have issues. :-)

CT, thanks again. Did you ever have trouble with your insurance refusing to cover Xifaxin for the purpose of treating pouchitis? I'm reading that they have been known to refuse coverage of the RX for non-IBD treatments.

quote:

Did you ever have trouble with your insurance refusing to cover Xifaxin for the purpose of treating pouchitis?

Never had trouble with coverage for Xifaxin and I have been with 4 or 5 different insurance companies/HMOs in the last 10 years, and I have taken Xifaxin for longer than that. My pouchitis IS considered IBD. I think my Doc writes it up as "ileitis."