Long-term Antibiotic Treatment in Pouchitis—Patterns of Use and Safety
| Autor: | Guy A. Weiss, Nir Bar, Uri Gophna, Lian Banon, Nathaniel A. Cohen, Nitsan Maharshak, Yoav Avraham, Hagit Tulchinsky, Vadim Dubinsky, Iris Dotan |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.drug_class medicine.medical_treatment Antibiotics Pouchitis Ciprofloxacin Metronidazole Internal medicine medicine Humans Immunology and Allergy Letters to the Editor Adverse effect Retrospective Studies Colectomy business.industry Proctocolectomy Restorative Gastroenterology medicine.disease Ulcerative colitis Anti-Bacterial Agents Cohort Colitis Ulcerative business medicine.drug |
| Zdroj: | Inflamm Bowel Dis |
| ISSN: | 1536-4844 1078-0998 |
| Popis: | IntroductionPouchitis, often developing after colectomy and ileal pouch-anal anastomosis for ulcerative colitis, is highly responsive to antibiotics. Ciprofloxacin and/or metronidazole are commonly used, often for prolonged periods. We report patterns of antibiotic use, adverse events, and resistant infections in patients with pouchitis with long-term antibiotic treatment.MethodsIn a cohort of patients following pouch surgery, a retrospective nested case-control analysis was performed between 2010 and 2017. Ultra-long-term use, defined as the top 10% of users, was compared with the remaining users. Patterns of antibiotic use, adverse events, and resistant infections were analyzed.ResultsThe cohort included 205 patients with UC, of whom 167 (81.5%) used antibiotics for pouchitis, predominantly ciprofloxacin. The long-term antibiotic use rate was 18% and 42% at 5 and 20 years postsurgery, respectively. Mean antibiotic use of at least 1, 3, and 6 months/year was noted in 54 (26.3%), 31 (15.1%), and 14 (6.8%) patients, respectively. Twenty-two (13.2%) and 4 (2.4%) patients reported mild and severe (transient) adverse events, respectively, without mortalities, tendinopathies or arrhythmias. Adverse event rates for ciprofloxacin and metronidazole were 1per 10,000 and 6 per 10,000 use-days, respectively. Longer, but not ultra-long antibiotic use, was associated with mild adverse events. There was no association between antibiotic use and resistant infections. Thirteen (6.3%) patients required ileostomy procedures—more commonly in the ultra-long-term antibiotic users.ConclusionsPatients with pouchitis may require prolonged antibiotic treatment, reflecting clinical benefit and favorable safety profile. Few adverse events and resistant infections were observed with long-term antibiotics use. However, resistant microbial strains selection, which are potentially transmittable, warrants consideration of different therapeutic alternatives. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|