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Long-term follow-up of the use of maintenance antibiotic therapy for chronic antibiotic-dependent pouchitis
  1. Jonathan P Segal1,2,
  2. Stephanie X Poo3,
  3. Simon D McLaughlin4,
  4. Omar D Faiz1,2,
  5. Susan K Clark1,2,
  6. Ailsa L Hart1,2
  1. 1St Mark’s Hospital, Harrow, UK
  2. 2Department of Surgery and Cancer, Imperial College, London, UK
  3. 3Imperial Healthcare NHS Trust, London, UK
  4. 4Department of Gastroenterology, The Royal Bournemouth and Christchurch Hospitals, Bournemouth, UK
  1. Correspondence to Dr Jonathan P Segal, St. Mark’s Hospital, Harrow HA1 3UJ, UK; jonathansegal{at}doctors.org.uk

Abstract

Objective Restorative proctolectomy is considered the procedure of choice in patients with ulcerative colitis who have failed medical therapy. Chronic pouchitis occurs in 10%–15% of patients, which often require long-term antibiotics to alleviate symptoms. Safety and efficacy of long-term maintenance antibiotics for chronic pouchitis has yet to be established. We aimed to assess the long-term safety and efficacy of maintenance antibiotic therapy for chronic pouchitis.

Design This was an observational study. We followed up patients who were diagnosed with chronic antibiotic-dependent pouchitis.

Setting Data were collected from our single specialist pouch centre.

Patients Patients with chronic antibiotic-dependent pouchitis who had been maintained on antibiotics continuously for at least 1 year with a least one follow-up visit.

Main outcome measure Development of pouch failure defined by the need for an ileostomy, patient-reported side effects of antibiotics and development of antibiotic resistance found on stool coliform testing.

Results Long-term use of antibiotics achieve remission in 21% of patients over a median follow-up of 102 (range 9–125). Pouch failure in association with chronic pouchitis after a median follow-up of 8.5 years occurred in 18%. Side effects of long-term antibiotic use occurred in 28% of patients, with resistance to antibiotics from at least one stool sample occurring in 78% patients.

Conclusions Although the use of antibiotics in chronic pouchitis may be justified, the use of long-term antibiotics must be weighed against potential complications associated with pouchitis and antibiotics.

  • antibiotics
  • pouchitis
  • inflammatory bowel disorders

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Footnotes

  • Contributors Guarantor of the article: ALH. JPS and SXP collected, managed and analysed the data. JPS, SXP and SDM reviewed the literature and prepared the manuscript. JPS, SXP, SDM, ALH, SKC and ODF have revised the manuscript critically and prepared the final version of the manuscript. All authors approved the final draft prior to submission.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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