An open study of maintenance antibiotic therapy for chronic antibiotic-dependent pouchitis: efficacy, complications and outcome.
OBJECTIVE
About 5% of restorative proctocolectomy (RPC) patients develop chronic antibiotic-dependent pouchitis. These require antibiotic maintenance therapy. We report our experience in managing this patient group.


METHODS
Patients with RPC that was treated with antibiotic maintenance therapy were identified from the hospital pouch database. Data including faecal antibiotic sensitivity, functional outcome, side effects and Cleveland Global Quality of Life (CGQOL) score were recorded.


RESULTS
Twenty-five patients were identified. The median length of treatment was 15.8 (range 3-62) months. Ten (40%) patients had pouchitis with co-existing prepouch ileitis. The median frequency of defecation was 7 (range 4-11)/24 h, the median clinical Pouch Disease Activity Index (PDAI) was 0 (range 0-1) and the CQGOL score was 0.7 (range 0.5-1.0). Of those who relapsed, three (50%) patients had achieved mucosal healing following the induction of remission. Failure of mucosal healing did not predict a reduced time to relapse (P = 0.18). Prepouch ileitis was associated with an increased risk of developing antibiotic resistance (P = 0.023). Treatment of this with alternating antibiotic combination therapy was successful in all cases.


CONCLUSIONS
Antibiotic maintenance therapy appears safe, well-tolerated and effective for the treatment of chronic antibiotic-dependent pouchitis. It results in an improved quality of life and function. Prepouch ileitis, but not failure of mucosal healing, is associated with an increased risk of developing antibiotic resistance.
McLaughlin
S D
SD
Department of Biosurgery and Surgical Technology, Imperial College, Chelsea and Westminster Hospital, London, UK. simon.mclaughlin@nhs.net
Clark
S K
SK
Tekkis
P P
PP
Ciclitira
P J
PJ
Nicholls
R J
RJ
D000328:Adult; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D020682:Cefixime / Q000008:administration & dosage / Q000627:therapeutic use; D003091:Colistin / Q000008:administration & dosage / Q000627:therapeutic use; D003672:Defecation; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009582:Nitrofurantoin / Q000008:administration & dosage / Q000627:therapeutic use; D019449:Pouchitis / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D016737:Proctocolectomy, Restorative; D011788:Quality of Life; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014295:Trimethoprim / Q000008:administration & dosage / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D019980:Amoxicillin-Potassium Clavulanate Combination; D009582:Nitrofurantoin; D020682:Cefixime; D014295:Trimethoprim; D003091:Colistin