title: A randomized clinical trial of ciprofloxacin and metronidazole to treat acute pouchitis.
abstract: Metronidazole is effective for the treatment of acute pouchitis after ileal pouch-anal anastomosis, but it has not been directly compared with other antibiotics. This randomized clinical trial was designed to compare the effectiveness and side effects of ciprofloxacin and metronidazole for treating acute pouchitis. 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 1,000 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. 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 10.1+/-2.3 to 3.3+/-1.7 (p = 0.0001), whereas metronidazole reduced the PDAI score from 9.7+/-2.3 to 5.8+/-1.7 (p = 0.0002). There was a significantly greater reduction in the ciprofloxacin group than in the metronidazole group in terms of the total PDAI (6.9+/-1.2 versus 3.8+/-1.7; p = 0.002), symptom score (2.4+/-0.9 versus 1.3+/-0.9; p = 0.03), and endoscopic score (3.6+/-1.3 versus 1.9+/-1.5; p = 0.03). None of patients in the ciprofloxacin group experienced adverse effects, whereas three patients in the metronidazole group (33%) developed vomiting, dysgeusia, or transient peripheral neuropathy. 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.
authors.affiliation: Center for Inflammatory Bowel Disease, Department of Gastroenterology, The Cleveland Clinic Foundation, Ohio 44195, USA. shenb@ccf.org
authors.forename: B
authors.initials: B
authors.lastname: Shen
authors.forename: J P
authors.initials: JP
authors.lastname: Achkar
authors.forename: B A
authors.initials: BA
authors.lastname: Lashner
authors.forename: A H
authors.initials: AH
authors.lastname: Ormsby
authors.forename: F H
authors.initials: FH
authors.lastname: Remzi
authors.forename: A
authors.initials: A
authors.lastname: Brzezinski
authors.forename: C L
authors.initials: CL
authors.lastname: Bevins
authors.forename: M L
authors.initials: ML
authors.lastname: Bambrick
authors.forename: D L
authors.initials: DL
authors.lastname: Seidner
authors.forename: V W
authors.initials: VW
authors.lastname: Fazio
mesh_terms: D000208:Acute Disease; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use*; D019449:Pouchitis / Q000188:drug therapy* / Q000473:pathology; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole; D002939:Ciprofloxacin