Researchers from England, Italy, and Germany evaluated the therapeutic efficacy of a prolonged course of a combination of two antibiotics in patients with refractory or recurrent pouchitis.
They also assessed its impact on their quality of life.
Patients recruited had a history of pouchitis at least twice in the last 12 months or persistent pouchitis requiring continual intake of antibiotics. They also had a Pouchitis Disease Activity Index score of 7 (best to worst pouchitis = 0-18) at the beginning of therapy.
Treatment consisted of a combination of metronidazole, 400 or 500 mg twice daily, and ciprofloxacin, 500 mg twice daily, for 28 days.
Symptomatic, endoscopic, and histological evaluations were undertaken before and after antibiotic therapy using the Pouchitis Disease Activity Index score.
Remission was defined as a combination of a Pouchitis Disease Activity Index clinical score of ≤2, endoscopic score of ≤1, and total score of ≤4.
The quality of life was assessed with the Inflammatory Bowel Disease Questionnaire, which encompasses bowel, systemic, and emotional symptoms, as well as social function (worst to best = 32-224).
A total of 44 patients (24 men, median age of 38 years) entered the trial and completed treatment.
Of these, 82% went into remission.
|82% went into remission after 4-week course of metronidazole and ciprofloxacin.
| Alimentary Pharmacology and Therapeutics |
The median Pouchitis Disease Activity Index scores before and after therapy were 12 and 3, respectively.
The researchers found that the median Inflammatory Bowel Disease Questionnaire score also significantly improved from 97 to 175 with this therapy.
The 8 patients (5 male) who did not go into remission were significantly older (median 48 vs 35 years) and had a longer history of pouchitis (96 vs 26 months), than those who went into remission.
They also had a greater proportion with chronic pouchitis (chronic/relapsing: 6/2 vs 9/27; relative risk, 1.6) and tended to have a higher Pouchitis Disease Activity Index score before treatment (median 15 vs 12)
Even in these 8 patients, the median Pouchitis Disease Activity Index score significantly improved from 15 to 10, as did the Inflammatory Bowel Disease Questionnaire score from 96 to 127.
The Inflammatory Bowel Disease Questionnaire score was found to strongly correlate with the Pouchitis Disease Activity Index score. It was also significantly related to the patients' overall assessment of satisfaction.
No serious side-effects were noted.
Author T. Mimura, of St Mark's Hospital, London, England, said on behalf of the group, "Four-week treatment with a combination of metronidazole and ciprofloxacin is highly effective in patients with active recurrent or refractory pouchitis, objectively improving the inflammation and quality of life."
"The Inflammatory Bowel Disease Questionnaire is a sensitive tool for evaluating patients with pouchitis, and correlates well with disease activity," it was concluded.