Shen B, Achkar J P, Lashner B A, Ormsby A H, Remzi F H, Brzezinski A, Bevins C L, Bambrick M L, Seidner D L, Fazio V W
Center for Inflammatory Bowel Disease, Department of Gastroenterology, The Cleveland Clinic Foundation, Ohio 44195, USA.
Inflamm Bowel Dis. 2001 Nov;7(4):301-5. doi: 10.1097/00054725-200111000-00004.
Metronidazole is effective for the treatment of acute pouchitis after ileal pouch-anal anastomosis, but it has not been directly compared with other antibiotics. This randomized clinical trial was designed to compare the effectiveness and side effects of ciprofloxacin and metronidazole for treating acute pouchitis. Acute pouchitis was defined as a score of 7 or higher on the 18-point Pouchitis Disease Activity Index (PDAI) and symptom duration of 4 weeks or less. Sixteen patients were randomized to a 2-week course of ciprofloxacin 1,000 mg/d (n = 7) or metronidazole 20 mg/kg/d (n = 9). Clinical symptoms, endoscopic findings, and histologic features were assessed before and after therapy. Both ciprofloxacin and metronidazole produced a significant reduction in the total PDAI score as well as in the symptom, endoscopy, and histology subscores. Ciprofloxacin lowered the PDAI score from 10.1+/-2.3 to 3.3+/-1.7 (p = 0.0001), whereas metronidazole reduced the PDAI score from 9.7+/-2.3 to 5.8+/-1.7 (p = 0.0002). There was a significantly greater reduction in the ciprofloxacin group than in the metronidazole group in terms of the total PDAI (6.9+/-1.2 versus 3.8+/-1.7; p = 0.002), symptom score (2.4+/-0.9 versus 1.3+/-0.9; p = 0.03), and endoscopic score (3.6+/-1.3 versus 1.9+/-1.5; p = 0.03). None of patients in the ciprofloxacin group experienced adverse effects, whereas three patients in the metronidazole group (33%) developed vomiting, dysgeusia, or transient peripheral neuropathy. Both ciprofloxacin and metronidazole are effective in treating acute pouchitis with significant reduction of the PDAI scores. Ciprofloxacin produces a greater reduction in the PDAI and a greater improvement in symptom and endoscopy scores, and is better tolerated than metronidazole. Ciprofloxacin should be considered as one of the first-line therapies for acute pouchitis.
甲硝唑对回肠储袋肛管吻合术后急性储袋炎的治疗有效，但尚未与其他抗生素进行直接比较。这项随机临床试验旨在比较环丙沙星和甲硝唑治疗急性储袋炎的有效性和副作用。急性储袋炎定义为在18分的储袋炎疾病活动指数（PDAI）上得分7分或更高且症状持续时间为4周或更短。16例患者被随机分为接受为期2周的环丙沙星1000mg/d治疗组（n = 7）或甲硝唑20mg/kg/d治疗组（n = 9）。在治疗前后评估临床症状、内镜检查结果和组织学特征。环丙沙星和甲硝唑均使PDAI总分以及症状、内镜检查和组织学分项得分显著降低。环丙沙星使PDAI评分从10.1±2.3降至3.3±1.7（p = 0.0001），而甲硝唑使PDAI评分从9.7±2.3降至5.8±1.7（p = 0.0002）。就PDAI总分（6.9±1.2对3.8±1.7；p = 0.002）、症状评分（2.4±0.9对1.3±0.9；p = 0.03）和内镜评分（3.6±1.3对1.9±1.5；p = 0.03）而言，环丙沙星组的降低幅度显著大于甲硝唑组。环丙沙星组无患者出现不良反应，而甲硝唑组有3例患者（33%）出现呕吐、味觉障碍或短暂性周围神经病变。环丙沙星和甲硝唑对治疗急性储袋炎均有效，可使PDAI评分显著降低。环丙沙星使PDAI降低幅度更大，症状和内镜检查评分改善更明显，且耐受性优于甲硝唑。环丙沙星应被视为急性储袋炎的一线治疗药物之一。
