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. 2023 Nov 1;118(11):1989-1996.
doi: 10.14309/ajg.0000000000002412. Epub 2023 Jul 19.

The Comparative Effectiveness of Ciprofloxacin and Metronidazole for an Initial Episode of Pouchitis: A Propensity-Matched Study

Edward L Barnes  1   2   3 , Aakash Desai  4 , Gursimran S Kochhar  5
Affiliations

The Comparative Effectiveness of Ciprofloxacin and Metronidazole for an Initial Episode of Pouchitis: A Propensity-Matched Study

Edward L Barnes et al. Am J Gastroenterol. .

Abstract

Introduction: There is minimal evidence regarding the comparative effectiveness of individual antibiotics in the treatment of pouchitis. We sought to evaluate the comparative effectiveness of ciprofloxacin monotherapy, metronidazole monotherapy, and combination therapy (ciprofloxacin and metronidazole) in the treatment of an initial episode of pouchitis after ileal pouch-anal anastomosis for ulcerative colitis (UC).

Methods: We performed a retrospective cohort study in TriNetX, a global federated research network of electronic health records. Primary outcomes were failure of initial antibiotic therapy and the development of recurrent pouchitis in the first 12 months after an initial episode of pouchitis. One-to-one propensity score matching was performed for age, sex, race, primary sclerosing cholangitis, nicotine dependence, obesity, and previous exposure to tumor necrosis factor inhibitors between the cohorts.

Results: Among 271 patients who developed pouchitis (mean age at ileal pouch-anal anastomosis 35.8 years, male sex 57%) and were treated with ciprofloxacin, metronidazole, or combination therapy, 190 (70%) developed recurrent pouchitis. After propensity score matching, there was no significant difference in the odds of early relapse or nonresponse with ciprofloxacin compared with metronidazole monotherapy (adjusted odds ratio 0.56, 95% confidence interval 0.23-1.34) or when either monotherapy was compared with combination therapy. There was also no significant difference in odds of recurrent pouchitis when comparing patients treated with ciprofloxacin with metronidazole monotherapy (adjusted odds ratio 0.86, 95% confidence interval 0.40-1.84) or either monotherapy with combination therapy.

Discussion: In this retrospective cohort study, we demonstrated no significant difference in the real-world effectiveness of ciprofloxacin, metronidazole, or combination therapy for the initial episode of pouchitis.

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Conflict of interest statement

Potential Competing Interests:

Edward L. Barnes has served as a consultant for Bristol-Meyers Squibb and Target RWE.

Aakash Desai: None

Gursimran Kochhar: Advisor Board: Lilly USA, CorVetas research foundation, GIE medical; Speaker: Lilly Pharma; Consultant: Pentax Endoscopy, Boston Scientific; Stock Options: DigbiHealth

Figures

Figure 1.
Figure 1.
Comparison of time to an episode of recurrent pouchitis among patients treated with ciprofloxacin or metronidazole for an initial episode of pouchitis after ileal pouch-anal anastomosis for ulcerative colitis Legend: A: Ciprofloxacin monotherapy vs. Metronidazole monotherapy; B: Ciprofloxacin monotherapy vs. Ciprofloxacin and Metronidazole combination therapy; C: Metronidazole monotherapy vs. Ciprofloxacin and Metronidazole combination therapy
See this image and copyright information in PMC

Comment in

References

    1. Barnes EL, Lightner AL, Regueiro M. Peri-operative and Post-operative Management of Patients with Crohn’s Disease and Ulcerative Colitis. Clin Gastroenterol Hepatol 2020;18:1356–1366. - PubMed
    1. Quinn KP, Raffals LE. An Update on the Medical Management of Inflammatory Pouch Complications. Am J Gastroenterol 2020;115:1439–1450. - PubMed
    1. Shen B, Kochhar GS, Kariv R, et al. Diagnosis and classification of ileal pouch disorders: consensus guidelines from the International Ileal Pouch Consortium. Lancet Gastroenterol Hepatol 2021;6:826–849. - PubMed
    1. Barnes EL, Herfarth HH, Kappelman MD, et al. Incidence, Risk Factors, and Outcomes of Pouchitis and Pouch-Related Complications in Patients With Ulcerative Colitis. Clin Gastroenterol Hepatol 2021;19:1583–1591. - PMC - PubMed
    1. Nguyen N, Zhang B, Holubar SD, et al. Treatment and prevention of pouchitis after ileal pouch-anal anastomosis for chronic ulcerative colitis. Cochrane Database Syst Rev 2019;5:Cd001176. - PMC - PubMed

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