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Combined Ciprofloxacin and Tinidazole Therapy in the Treatment of Chronic Refractory Pouchitis

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Diseases of the Colon & Rectum

Purpose

Management of chronic refractory pouchitis, a common cause for pouch failure with pouch resection or diversion, is often challenging. The aim of this study was to assess the efficacy and safety of a combination therapy of ciprofloxacin and tinidazole in patients with chronic refractory pouchitis compared with mesalamine therapy.

Methods

Sixteen consecutive ulcerative colitis patients with chronic refractory pouchitis (disease>4 weeks and failure to respond to>4 weeks of single-antibiotic therapy) were treated with a four-week course of ciprofloxacin 1 g/day and tinidazole 15 mg/kg/day. A historic cohort of ten consecutive patients with chronic refractory pouchitis treated with oral (4 g/day), enema (8 g/day), or suppository (1 g/day) mesalamine served as controls. The Pouchitis Disease Activity Index, clinical remission, clinical response, the Cleveland Global Quality of Life, the Irritable Bowel Syndrome-Quality of Life, and the Short Inflammatory Bowel Disease Questionnaires scores were calculated before and after therapy and compared between the two treatment groups.

Results

Patients taking ciprofloxacin and tinidazole had a significant reduction in the total Pouchitis Disease Activity Index scores and subscores and a significant improvement in quality-of-life scores (P < 0.002). For patients in the mesalamine group, there was a significant reduction in the total Pouchitis Disease Activity Index scores only. Patients in the antibiotic group had a greater reduction in the total Pouchitis Disease Activity Index scores and a greater improvement in the quality-of-life scores than those in the mesalamine group (P ≤ 0.03). The rate of clinical remission and clinical response for the antibiotic group was 87.5 percent and 87.5 percent, respectively, and for the mesalamine group it was 50 percent and 50 percent, respectively (P = 0.069). Two patients in the antibiotic group (peripheral neuropathy and dysgeusia) developed adverse effects.

Conclusions

Combination therapy with ciprofloxacin and tinidazole was generally well tolerated and was effective in treating patients with chronic refractory pouchitis.

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Authors and Affiliations

  1. Department of Gastroenterology/Hepatology, Center for Inflammatory Bowel Disease, Cleveland Clinic, Cleveland, Ohio

    Bo Shen M.D., Rocio Lopez M.S., M.P.H., Aaron Brzezinski M.D., Ioannis Oikonomou M.D., Kerry K. Sherman R.N., B.S.N. & Bret A. Lashner M.D.

  2. Department of Colorectal Surgery, Center for Inflammatory Bowel Disease, Cleveland Clinic, Cleveland, Ohio

    Victor W. Fazio M.B., M.S. & Feza H. Remzi M.D.

  3. Department of Anatomic Pathology, Center for Inflammatory Bowel Disease, Cleveland Clinic, Cleveland, Ohio

    Ana E. Bennett M.D.

  4. Department of Gastroenterology/Hepatology, Desk A30, Cleveland Clinic, 9500 Euclid Ave., Cleveland, Ohio, 44195

    Bo Shen M.D.

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  1. Bo Shen M.D.
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  2. Victor W. Fazio M.B., M.S.
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  3. Feza H. Remzi M.D.
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  6. Aaron Brzezinski M.D.
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  8. Kerry K. Sherman R.N., B.S.N.
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  9. Bret A. Lashner M.D.
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Correspondence to Bo Shen M.D..

Additional information

Supported by National Institutes of Health grant NIH R03 DK 067275 and an American College of Gastroenterology Clinical Research Award (to B. S.).

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Shen, B., Fazio, V.W., Remzi, F.H. et al. Combined Ciprofloxacin and Tinidazole Therapy in the Treatment of Chronic Refractory Pouchitis. Dis Colon Rectum 50, 498–508 (2007). https://doi.org/10.1007/s10350-006-0828-3

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