I think the most common thing after antibiotics is probiotics and after that biologics. I am now trying to keep pouchitis at bay by taking 2 packets of Visbiome daily. Visbiome is a probiotic meant pouchitis, VSL3 is basically the same stuff. It's not cheap but it makes a difference for some of us.

Good luck

Echoing Pouchlogic’s suggestion that a high probiotic dose can sometimes help. Though I’m on full-time antibiotics now, VSL #3 helped me delay that for a year. I still take a very high dose (4 double strength packets daily), and I think it still helps.

Some folks have also had good luck with a *very* low carbohydrate diet. It doesn’t work quickly, and it can be hard to stick with, but it’s probably worth a try for you.

I am currently on the biologic Entyvio.  It has helped tremendously with chronic pouchitis flares. I'm also on Imuran and budesonoide. 

Another thing I do is watch the sugar.  I haven't given it up totally, but have decreased the amount I eat.  When I OD on sugar, I'm asking for pouchitis. (No more waffle cones for me when on vacation. So sad!) I'm also trying to cut down on the amount of fruit I eat, since it affects blood sugar.

Thank you for all suggestions.

Question about VSL#3. I tried it a few years ago for a short period. I stopped because it was super expensive and I didn’t see any changes (but I only took for a short period). Has the price became more reasonable or is it still very expensive? Also, how long did you take it before you noticed improvement?

It’s still very expensive. It’s not very effective at treating an active case of pouchitis, so the benefit (if you experience it) would be fewer/milder episodes of pouchitis in the future. So it takes a long time to have any confidence that it’s helping.

That’s interesting that sugar sparks a pouchitis flare for you, Still Standing. I love my chocolate, and would hate to give up my indulgences but if it helps prevent my symptoms, I guess it’s something to look into. I’ve been trying to go off a low dose of Cipro and can’t seem to shake it without symptoms returning.