Topical metronidazole treatment in Pouchitis

Nygaard K. Bcrgan T, Bjomeklett A. Hoverstad T, Lassen J, Aase S. Topical metronidazole treatment in pouchitis. Scand J Gastroenterol 1994:29:462-467.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 dailv. 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 flor...