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Metronidazole is effective for treating patients with acute pouchitis after total proctocolectomy for ulcerative colitis. Ciprofloxacin also is used with these patients, often as second-line therapy. To compare the 2 drugs, researchers randomized 16 patients with acute pouchitis to receive ciprofloxacin (1000 mg/day) or metronidazole (20 mg/kg/day) for 2 weeks. 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. Clinical symptoms, endoscopic findings, and histologic features were assessed before and after therapy.
Both antibiotics significantly reduced total PDAI scores, but the mean reduction was greater with ciprofloxacin than with metronidaz…