Patients with
pouchitis usually respond to oral
metronidazole treatment, but side effects of the treatment are common. Eleven patients with
pouchitis were given local treatment by instillation of
metronidazole in doses of 40-160 mg daily into the reservoir. The effects of the treatment on the bacterial flora and
short-chain fatty acids in reservoir contents, morphology of the ileal mucosa, and serum concentrations of
metronidazole were studied. All patients responded to local administration of
metronidazole. Three patients with chronic
pouchitis remained well for 6 months, 3 years, and 4 years, taking 40 mg
metronidazole daily. Three patients had one single treatment course, and four had repeated courses when they had recurrences. In one patient a continent reservoir had to be removed owing to a persistent
ulcer causing chronic blood loss. The bacterial flora of reservoir contents showed no significant differences between patients with and without
pouchitis. The number of anaerobic microorganisms and the concentration of
short-chain fatty acids were reduced after
metronidazole treatment. Serum concentrations of
metronidazole were very low, and no patients experienced any side effects of the treatment. In conclusion, topical application of small doses of
metronidazole relieved symptoms in most cases of
pouchitis and was well tolerated, even as long-term treatment.