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Fistulas, to continue antibiotics or to forget about them??

n/an/aMember
For those of you with fistulas (and Jan?) - I've been on antibiotics, more or less, for about 2 years - since my fistula was found. While on them, my drainage seems to slow down; when I try to get off them by decreasing the dosage, the drainage increases. Nothing TOO crazy, but it's there. I have a seton keeping it open. And naturally, my jpouch has been fairly well behaved on the antibiotics.

So I'm wondering ... does having more drainage running through the fistula tract decrease any chance the fistula has of healing? I just don't want to make the fistula more infected, or "worse", if I quit the abx. The drainage I guess I can handle if it's not too severe. However, the thought that more drainage - due to quitting antibiotics - could make the fistula "worse" is something I obviously want to avoid.

To throw another wrench into the mix, since I've decreased my dose to the minimum, I've been feeling flu-like, which is the same as I felt - for many years - before the fistula was discovered.

Anyone have any experience they can share, or Jan - any thoughts?
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C cdeckerMember
Fistula's are tough to deal with. My husband has an abdomnal fisutla with a smaller amount of output. But when he goes off the antiobiotics the same thing happens to him. His is fairly new only popped up two months ago. They are treating with antiobiotics to see if it closes on its own. Which it does but then it blisters and re-opens. Surgery might be the next option if his does not close on its own in the correct order.
n/an/aMember
I sympathize with you and your husband, cdecker, and hope antibiotics will do the job for him.

This problem with fistulas - that drainage increases after going off antibiotics - seems to be pretty common. I wish I understood the buggers better to know whether going off the abx - especially after being on them 2 years - will or won't make a difference as to whether they will ever heal or not. After this long, though, I'm expecting mine won't heal w/o surgery.

Best of luck to your hubby ---
Jan DollarJan DollarModerator, RN, retired
I doubt it makes a difference one way or the other in regard to healing, particularly since you have the seton. The logical mind tells you that nothing could heal with that nasty drainage there, but this is not purely logical.

So, the bottom line is that the antibiotics are for symtomatic relief. If you feel better and have fewer symptoms on them, then stay on them, particularly if it is low dose. What sort of seton is this? Is is just a draining seton or a cutting seton? Probably doesn't make a difference either way, but with a draining seton, the fistula won't heal as long as the seton is in there, but the abscess pocket can shrink. The cutting seton gradually cuts through the sphincter until it goes all the way through, healing behind it as it goes.

Jan Smiler
n/an/aMember
Thanks Jan - that's what my surgeon said, in so many words - take antibiotics as I see fit and if they make me feel better. I'm on 250 mg. levaquin/day, and switch that up with augmentim.

I have a draining seton. Makes sense that the fistula won't close as long as the seton is in, but maybe "heal", as in good tissue replace bad tissue and drainage (pus, I think) mostly end? I guess that's just me trying to think positive.

Here is an aside - and a positive note - I've quit bad carbs/sugars (SCD diet, with a few modifications, as I will not, under any circumstances, give up my dark chocolate), and my jpouch has never been happier. We'll see how it works long-term.

The diet does not appear to affect the fistula, unfortunately. However, it is absolutely worth looking into for those of you with pouchitis issues.

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