TOPICAL METRONIDAZOLE TREATMENT IN POUCHITIS

Patients with pouchitis usually respond to oral metronidazole treatmen t, but side effects of the treatment are common. Eleven patients with pouchitis were given local treatment by instillation of metronidazole in doses of 40-160 mg daily into the reservoir. The effects of the tre atment on the bacterial flora and short-chain fatty acids in reservoir contents, morphology of the ileal mucosa, and serum concentrations of metronidazole were studied. All patients responded to local administr ation of metronidazole. Three patients with chronic pouchitis remained well for 6 months, 3 years, and 4 years, taking 40 mg metronidazole d aily. Three patients had one single treatment course, and four had rep eated courses when they had recurrences. In one patient a continent re servoir had to be removed owing to a persistent ulcer causing chronic blood loss. The bacterial flora of reservoir contents showed no signif icant differences between patients with and without pouchitis. The num ber of anaerobic microorganisms and the concentration of short-chain f atty acids were reduced after metronidazole treatment. Serum concentra tions of metronidazole were very low, and no patients experienced any side effects of the treatment. In conclusion, topical application of s mall doses of metronidazole relieved symptoms in most cases of pouchit is and was well tolerated, even as long-term treatment.