Only one antibiotic at a time?

Hi JD, my first pouchitis (or SIBO - it was never clear) was treated beautifully with Cipro alone. It's not as effective anymore and I am currently on Cipro and Xifaxin. I don't do well on Flagyl either. It gave me terrible migraines and general blah feeling.

to deal with my pouchitis/s.i.b.o. i take one antibiotic at a time try to make a few to 3 weeks then rotate to another...never needed two at a time yet o in all these years and with my dcd diet i have been able to get by on 1/2 the dosage except for xifaxin which i tale 600 mil twice a day..but before diet could never take xifaxin it never worked..

Cipro and flagyl are often prescribed together because they are from different antibiotic families, work on different bacteria and give you the broadest possible spectrum of coverage. Levacquin and cipro come from the same family of antibiotics (Fluoroquinolone) and should never be taken together or rotated one after the other, as you don't marry antibiotics within one family. An ideal rotation (if tolerated) is cipro and flagyl, then xifaxin, and then augmentin.

Antibiotic combinations are best used when a single antibiotic alone doesn't do the trick. Cipro alone worked for me for a couple of years, but lately I've had to add Flagyl.

Thanks for the info. I'll see if Levaquin alone does the trick.

most people find after a while the antibiotic used is not as effective..rotating the antibiotics can be substituted..

there are those of us who can stay on one for very long period of time however,its trial and error we are all different as to how long or if they work..

I was actually coming to post this question. I did a 2 week round of cipro and felt great-until I came off it. Definitely still having pouchitis. My GI called me in another round of cipro, but in the interim I saw my Primary for something else, explained this rough round of inflammation, and she offered to also prescribe me flagyl to really knock it out. I'm not sure what to do because it's not my GI prescribing it so I almost feel like I'm doing something wrong...he was hesitant to give me the cirpo and is more conservative with treatments - although my old (now retired) GI knocked out a comparably bad round of the itis with the cipro/flagyl combo. I remember that one worked for a long time after...

I'm not sure what to do; should I take the flagyl now too to kick what is easily the worst case I've ever had? Or should I trust my GI, take the cipro, and if it comes back again then ask him about the flagyl? I'd really like to knock this out because it's been a month of little sleep, weight loss, no appetite, cramping, etc - and my school year starts next week.

CaySeeBee. I've had my pouch for 15 years. I've seemed to get pouchitis around once a year or so. Maybe once every 9 months. If you can handle flagyl, then definitely do both. I've found that when my pouchitis is bad that I absolutely have to take two antibiotics at a time to knock it out. The case I have now is slight and I caught it early, so I'm trying just Levaquin. If I had caught it later, I would be doing both. Flagyl probably will help you. I just didn't want to deal with the side effects right now. You'll find through the years that you may come to know more about your pouch than most doctors and that the people on this site know more too. Good luck.

The combination isn't very risky, and it's not like you got the Flagyl illicitly. Your GI will just need an update, however it turns out. Whatever you decide, good luck!

Thanks for the input. JD, your last sentence is what I've been telling myself lately. My GI is a brilliant clinician, but I've only been working with him for 3 years and this is easily the worst flare (and only real issue) I've had in that time frame. Otherwise I saw him twice a year for check ins/scopes. There were 11 rough years of UC, surgeries, pouchitis before him and my old doctor, who held my hand through it all, would absolutely have prescribed me both had he seen the last scope. Even I could tell how bad the infection was - as could my PCP which is why she made the offer. The best part is I didn't start treatment until a week AFTER that scope,because my GI thought that dilating the stricture may clear up the infection and he, understandably, didn't want to put me on heavy duty meds until it was absolutely necessary. But again, old doctor wouldn't have hesitated. But old doctor knew how my body worked. It's tough - both my GI and surgeon from that time have left me (retired, moved out of state). I don't trust my new team as much. It kind of sucks.

Sigh. I think I will call my PCP and get that prescription. This is the worst pouch flare I've had since my first one - when I didn't realize what was going on. I tolerate flagyl fine - I was on it for 6 months with UC and did start developing neuropothy (which cleared up), but I've taken shorter doses of it since and had no problems. It's more the lifestyle stuff (no alcohol) that prohibits me for asking for it; but I can make that sacrifice for a few weeks. I'm not drinking much now, anyway, as it pisses my stomach off.