Long-term antibiotics vs biologics

There isn't enough research to reliably compare biologics vs. antibiotics for chronic pouchitis. Efficacy and side effects generally drive the decision, along with whatever preferences doctors may have developed. For recurrent acute pouchitis that genuinely stays away for as long as 3 months I think most gastroenterologists would suggest antibiotics, as long as they are effective and well tolerated. This would also be an excellent situation in which to try probiotics (especially a very strong one such as Visbiome) to lengthen the time between recurrences.

Just to add a bit to Scott’s response, there really is no universally accepted guide, as it should be an individual approach. It depends on the type of pouchitis you have, and your treatment response. It is quite complex because there are so many variables that factor into a pouchitis diagnosis. All treatments have their risks and benefits.

For me, my GI preferred to get me off the antibiotic merry-go-round. It turned out to be a good choice for me.

If you are going to go with chronic antibiotic use, the lowest dose and frequency that prevents relapse is the best for avoiding side effects.

Here is a link to a good article about current trends for chronic pouchitis treatment:

https://fg.bmj.com/content/16/2/143

Jan