Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Inflamm Bowel Dis. 2022 Jul 1;28(7):1027-1033. doi: 10.1093/ibd/izab209.
Pouchitis, often developing after colectomy and ileal pouch-anal anastomosis for ulcerative colitis, is highly responsive to antibiotics. Ciprofloxacin and/or metronidazole are commonly used, often for prolonged periods. We report patterns of antibiotic use, adverse events, and resistant infections in patients with pouchitis with long-term antibiotic treatment.
In a cohort of patients following pouch surgery, a retrospective nested case-control analysis was performed between 2010 and 2017. Ultra-long-term use, defined as the top 10% of users, was compared with the remaining users. Patterns of antibiotic use, adverse events, and resistant infections were analyzed.
The cohort included 205 patients with UC, of whom 167 (81.5%) used antibiotics for pouchitis, predominantly ciprofloxacin. The long-term antibiotic use rate was 18% and 42% at 5 and 20 years postsurgery, respectively. Mean antibiotic use of at least 1, 3, and 6 months/year was noted in 54 (26.3%), 31 (15.1%), and 14 (6.8%) patients, respectively. Twenty-two (13.2%) and 4 (2.4%) patients reported mild and severe (transient) adverse events, respectively, without mortalities, tendinopathies or arrhythmias. Adverse event rates for ciprofloxacin and metronidazole were 1per 10,000 and 6 per 10,000 use-days, respectively. Longer, but not ultra-long antibiotic use, was associated with mild adverse events. There was no association between antibiotic use and resistant infections. Thirteen (6.3%) patients required ileostomy procedures-more commonly in the ultra-long-term antibiotic users.
Patients with pouchitis may require prolonged antibiotic treatment, reflecting clinical benefit and favorable safety profile. Few adverse events and resistant infections were observed with long-term antibiotics use. However, resistant microbial strains selection, which are potentially transmittable, warrants consideration of different therapeutic alternatives.
溃疡性结肠炎患者接受结肠切除和回肠储袋-肛门吻合术后常发生储袋炎，对抗生素高度敏感。环丙沙星和/或甲硝唑通常被广泛使用，且常需要长期使用。我们报告了接受长期抗生素治疗的储袋炎患者的抗生素使用模式、不良事件和耐药感染情况。
在一项接受储袋手术后的患者队列中，我们于 2010 年至 2017 年期间进行了回顾性嵌套病例对照分析。将超长期使用（定义为使用人数排名前 10%）与其余使用者进行比较。分析了抗生素的使用模式、不良事件和耐药感染情况。
该队列包括 205 例 UC 患者，其中 167 例（81.5%）因储袋炎使用了抗生素，主要是环丙沙星。术后 5 年和 20 年的长期抗生素使用率分别为 18%和 42%。54 例（26.3%）、31 例（15.1%）和 14 例（6.8%）患者分别至少使用了 1、3 和 6 个月/年的抗生素。分别有 22 例（13.2%）和 4 例（2.4%）患者报告了轻微和严重（短暂）不良事件，但无死亡、肌腱病或心律失常。环丙沙星和甲硝唑的不良事件发生率分别为每 10000 个用药日 1 例和 6 例。更长但非超长期的抗生素使用与轻微不良事件相关。抗生素使用与耐药感染之间没有关联。13 例（6.3%）患者需要进行回肠造口术——在超长期使用抗生素的患者中更为常见。
储袋炎患者可能需要长期接受抗生素治疗，这反映了临床获益和良好的安全性。长期使用抗生素观察到的不良事件和耐药感染很少。然而，耐药微生物菌株的选择（可能具有传染性）需要考虑不同的治疗选择。
