Long-term Antibiotic Treatment in Pouchitis-Patterns of Use and Safety

被引:14
作者
Bar, Nir [1 ,2 ]
Avraham, Yoav [2 ]
Dubinsky, Vadim [3 ]
Cohen, Nathaniel A. [1 ,2 ]
Weiss, Guy A. [4 ]
Banon, Lian [2 ,5 ]
Tulchinsky, Hagit [2 ,6 ]
Maharshak, Nitsan [1 ,2 ]
Gophna, Uri [3 ]
Dotan, Iris [2 ,7 ]
机构
[1] Tel Aviv Sourasky Med Ctr, Dept Gastroenterol & Hepatol, Tel Aviv, Israel
[2] Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel
[3] Tel Aviv Univ, George S Wise Fac Life Sci, Sch Mol Cell Biol & Biotechnol, Tel Aviv, Israel
[4] Univ Calif Los Angeles, Vatche & Tamar Manoukian Div Digest Dis, Celiac Dis Program, Los Angeles, CA USA
[5] Tel Aviv Sourasky Med Ctr, Internal Med H, Tel Aviv, Israel
[6] Tel Aviv Med Ctr & Sch Med, Dept Surg, Colorectal Unit, Tel Aviv, Israel
[7] Rabin Med Ctr, Div Gastroenterol, 39 Jabotinski St, IL-49100 Petah Tiqwa, Israel
关键词
ciprofloxacin; metronidazole; pouchitis; chronic antibiotic use; ILEAL POUCH; CLOSTRIDIUM-DIFFICILE; ANAL ANASTOMOSIS; ULCERATIVE-COLITIS; METRONIDAZOLE; COMPLICATIONS; INFECTION; RISK;
D O I
10.1093/ibd/izab209
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Introduction 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. Methods 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. Results 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. Conclusions 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.
引用
收藏
页码:1027 / 1033
页数:7
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