The following is a summary of “Comparative Effectiveness of Ciprofloxacin and Metronidazole for an Initial Episode of Pouchitis: A Propensity-Matched Study,” published in the November 2023 issue of Gastroenterology by Barnes, et al.

Limited evidence exists regarding the comparative effectiveness of specific antibiotics in treating pouchitis. For a study, researchers sought to assess the comparative effectiveness of ciprofloxacin monotherapy, metronidazole monotherapy, and combination therapy (ciprofloxacin and metronidazole) for the initial episode of pouchitis following ileal pouch-anal anastomosis for ulcerative colitis (UC).

Conducted as a retrospective cohort study within TriNetX, a global federated research network of electronic health records, the primary outcomes assessed were the failure of initial antibiotic therapy and the development of recurrent pouchitis within the first 12 months post-initial episode. Across the cohorts, one-to-one propensity score matching was executed for factors including age, sex, race, primary sclerosing cholangitis, nicotine dependence, obesity, and previous exposure to tumor necrosis factor inhibitors.

Among the 271 patients treated with ciprofloxacin, metronidazole, or combination therapy for pouchitis (mean age at ileal pouch-anal anastomosis 35.8 years, male sex 57%), 190 (70%) experienced recurrent pouchitis. After propensity score matching, no significant difference was observed in the odds of early relapse or nonresponse between ciprofloxacin and metronidazole monotherapy (adjusted odds ratio 0.56, 95% CI 0.23–1.34) or between either monotherapy and combination therapy. Similarly, there was no significant difference in the odds of recurrent pouchitis when comparing ciprofloxacin with metronidazole monotherapy (adjusted odds ratio 0.86, 95% CI 0.40–1.84) or either monotherapy with combination therapy.

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

Source: journals.lww.com/ajg/abstract/2023/11000/the_comparative_effectiveness_of_ciprofloxacin_and.20.aspx