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.