Antibiotics should have a remarkable effect within 2 or 3 days. If not so, you need to increase dosage and / or add Flagyl to the Cipro which is a standard combination for pouchitis. Or switch to other antitiotics.

I also have a calming effect on inflammation by Entocort (budesonide), but that's not really cheap.

I don’t know your history, Joe, but an adequate dose of Cipro always worked astonishingly quickly for me, certainly within a day or two. After two weeks you’re well past time to contact your doctor for a course correction.

Thanks Steve and Scott for your responses.

Scott, I’m about nine months post-takedown and have been struggling with pouchitis since April. I have the typical increased frequency and urgency, but I also have intense discomfort (and even pain) in my pelvis and tailbone from the inflammation. If I am on my feet for more than a couple hours a day, I wind up with a feeling of intense pressure bearing down on my anus/perineum which I find really hard to manage, and which doesn’t go away until I go to bed.

Before this current dose of cipro, I did a two week course of cipro and flagyl (two pills/day for each) in May which was a freaking miracle. Every symptom I just described was gone in a couple of days. When the symptoms inevitably returned after the two weeks, my doctor tried a two week dose of amoxicillin. That improved things, but it did not work nearly as well as the cipro/flagyl combo. And after the symptoms came back yet again, it seems clear I’m among the lucky ones of us with chronic pouchitis.

So this is where I am. I strongly suspected based on my history that the cipro is just not working at its current dosage (and it may not work on its own whatever the dosage), but I wanted to take the pulse of the community to see if cipro just takes longer to work at lower dosages.

If I’m reading this right then Flagyl alone might do the trick for you. It’s also possible that the Cipro dose is just too low, but I think I’d try Flagyl alone at the dose that worked for you in combination. If that doesn’t work I’d retry the original effective dose sets of both. IMO the time to try reducing the dosage is when things are great - that way you can tell if the dose has gotten too low.

I take  Xifaxin for my pouchitis when it appears. Thankfully, it is not often now.  Previously ( a few years ago)  I had 2-3 bouts per year. This medicine is not cheap in the U.S.A.  I purchase with a Rx from a Canadian pharmacy. My J-pouch is 21 years old.

Low dose Cipro does not work for me, and I take 1000 mg a day.  As soon as I try to lessen, pouchitis comes back with a vengeance.  If you can boost your dosage, that might help.  I've been on Cupro/this dosage for nearly one year  and it made a HUGE difference after 3 years of hell (pouch in 2020).