| Title | Fecal coliform testing to identify effective antibiotic therapies for patients with antibiotic-resistant pouchitis. | | Author(s) | McLaughlin SD, Clark SK, Shafi S, Petrovksa L, Tekkis PP, Ciclitira PJ, Nicholls RJ | | Institution | Department of Biosurgery and Surgical Technology, Imperial College London.; Department of Gastroenterology, St. Mark's Hospital, London.; Nutritional Sciences Division, King's College London. | | Source | Clin Gastroenterol Hepatol 2009 Jan 14. | | Abstract | 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. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19559001 |
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