Medical management of acute idiopathic pouchitis

IBD: inflammatory bowel disease; NSAIDs: nonsteroidal anti-inflammatory drugs.

* Patients with acute idiopathic pouchitis have endoscopic evidence of active pouch inflammation without a clear cause identified on histology, stool studies, or blood tests. Refer to UpToDate content on the diagnosis of acute pouchitis.

¶ Ciprofloxacin is typically used for initial therapy, while metronidazole or tinidazole are reasonable alternatives.

Δ If susceptibility testing is not available, an alternative approach is an empiric dual antibiotic regimen (eg, ciprofloxacin plus metronidazole) for 4 weeks.

◊ Patients with <3 episodes of pouchitis per year are treated with a single antibiotic agent as needed. The antibiotic agent that was effective initially may be used again.

§ Laboratory testing including stool specimen for Clostridioides (formerly Clostridium) difficile is performed to confirm that secondary causes and coexisting conditions have been excluded.

¥ An alternative option for maintenance therapy is an antibiotic (eg, rifaximin).