Ciprofloxacin on par with metronidazole for pouchitis

A propensity-matched study has found no significant difference in the effectiveness of ciprofloxacin, metronidazole, or combination therapy in the real-world setting for an initial episode of pouchitis after ileal pouch-anal anastomosis for ulcerative colitis.

A group of researchers conducted a retrospective cohort study in TriNetX, a global federated research network of electronic health records. Failure of initial antibiotic therapy and recurrence in the first 12 months after an initial episode of pouchitis served as the primary outcomes.

The research team also performed one-to-one propensity score matching for age, sex, race, primary sclerosing cholangitis, nicotine dependence, obesity, and previous exposure to tumour necrosis factor inhibitors between cohorts.

Some 271 patients developed pouchitis (mean age at ileal pouch-anal anastomosis 35.8 years, male sex 57 percent) and received ciprofloxacin, metronidazole, or combination therapy. Of these, 190 (70 percent developed recurrent pouchitis.

No significant difference was observed in the likelihood of early relapse or nonresponse between treatment with ciprofloxacin and metronidazole monotherapy (adjusted odds ratio [aOR], 0.56, 95 percent confidence interval [CI], 0.23‒1.34) or between combination therapy and either monotherapy after propensity score matching.

Likewise, no significant difference was seen in the likelihood of recurrent pouchitis between patients treated with ciprofloxacin and those who received metronidazole monotherapy (aOR, 0.86, 96 percent CI, 0.40‒1.84) or between combination therapy and either monotherapy.