Fecal coliform testing to identify effective antibiotic therapies for patients with antibiotic-resistant pouchitis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] Journal article

BACKGROUND & AIMS:: Empirical antibiotic therapy (e.g. a combination of ciprofloxacin and metronidazole) is effective in treating the majority of patients with inflammation of the ileal reservoir (pouchitis). Unfortunately, up to 20% of patients develop refractory or rapidly relapsing disease. We developed a fecal sensitivity analysis to determine which antibiotics are most likely to be effective in patients who do not respond to empirical antibiotic therapy or have relapsed following long-term therapy.
METHODS:: Fecal samples from 15 patients with active pouchitis (pouch disease activity index [PDAI] =7) who failed standard antibiotic treatment were inoculated onto iso-sensitest agar. Antibiotic testing discs were added, incubated, and sensitivity patterns were recorded. Patients were then treated with antibiotics based on predicted sensitivity; PDAI scores were assessed 4 weeks later. Thirteen patients enrolled in the study had failed to enter remission following treatment with ciprofloxacin and metronidazole and 2 had relapsed following maintenance treatment with ciprofloxacin.
RESULTS:: Antibiotic coliform sensitivity testing showed ciprofloxacin resistance in all samples, co-amoxiclav resistance in 4 samples, trimethoprim resistance in 11 samples and cefixime resistance in 8 samples. All 15 patients were treated with an antibiotic to which their fecal coliforms were sensitive; 12 (80%) achieved clinical remission (PDAI scores of 0).
CONCLUSION:: Fecal coliform sensitivity analysis can identify effective antibiotic therapies for patients with antibiotic-resistant pouchitis. This targeted antibiotic approach is recommended in all patients who fail to respond to empirical antibiotic treatment or relapse following long-term antibiotic therapy.

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol]