Treatment
There is no clinically approved treatment for pouchitis. First line treatment is usually with antibiotics, specifically with ciprofloxacin and metronidazole. Ampicillin or Piperacillin can also be considered as alternatives to empiric Ciprofloxacin and metronidazole). Administration of metronidazole at a high daily dose of 20 mg/kg can cause symptomatic peripheral neuropathology in up to 85% of patients. This can be a limiting factor in the use of maintenance metronidazole to suppress chronic pouchitis.
Other therapies which have been shown to be effective in randomised clinical trials include probiotic therapy. Biologics, such as anti-TNF antibodies, may also be useful but the evidence for their use is largely anecdotal.
Half of the chronic, unremitting pouchitis population will eventually require surgical treatment of the pouch.
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