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News

Ciprofloxacin should be considered as first-line therapy for acute pouchitis

Ciprofloxacin is more effective and better tolerated than metronidazole in the treatment of acute pouchitis, and should be considered as one of the first-line therapies for this condition, claim researchers from Cleveland, Ohio, USA.

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The team compared the effectiveness and side-effects of ciprofloxacin and metronidazole for treating acute pouchitis, and reported their findings in November's Inflammatory Bowel Diseases.

Metronidazole is effective for the treatment of acute pouchitis after ileal pouch-anal anastomosis, but it has not been directly compared with other antibiotics.

Acute pouchitis was defined as a score of 7 or higher on the 18-point Pouchitis Disease Activity Index (PDAI) and symptom duration of 4 weeks or less.

Sixteen patients were randomized to a 2-week course of ciprofloxacin 1000 mg/d (n = 7) or metronidazole 20 mg/kg/d (n = 9).

Clinical symptoms, endoscopic findings, and histologic features were assessed before and after therapy.

It was found that both ciprofloxacin and metronidazole produced a significant reduction in the total PDAI score, as well as in the symptom, endoscopy, and histology subscores.

Ciprofloxacin lowered the PDAI score from a median of 10.1 to 3.3, whereas metronidazole reduced the PDAI score from 9.7 to 5.8.

Benefits of ciprofloxacin:
- PDAI reduced
- Symptom score improved
- Endoscopy score improved
- Well tolerated
Inflammatory Bowel Disease

There was a significantly greater reduction in the ciprofloxacin group than in the metronidazole group in terms of the total PDAI (6.9 versus 3.8), symptom score (2.4 versus 1.3), and endoscopic score (3.6 versus 1.9).

The researchers found that none of patients in the ciprofloxacin group experienced adverse effects. However, 3 patients in the metronidazole group (33%) developed vomiting, dysgeusia, or transient peripheral neuropathy.

Bo Shen, of the Cleveland Clinic Foundation, commented on behalf of the group, "Both ciprofloxacin and metronidazole are effective in treating acute pouchitis with significant reduction of the PDAI scores.

"Ciprofloxacin produces a greater reduction in the PDAI and a greater improvement in symptom and endoscopy scores, and is better tolerated than metronidazole."

"Ciprofloxacin should be considered as one of the first-line therapies for acute pouchitis," it was concluded.

Inflamm Bowel Dis 2001; 7(4): 301-5
29 November 2001

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