Metronidazole post surgery - what's your experience?

[Pigeon]

I've had a bowel resection in February and was then put on Metro in May. In theory I should be taking this for 3 months and then will not be on any meds assuming all goes well.

But I'm having a side-effect, joint pains, which are getting worse and which my GP cannot guarantee will go away so am thinking about coming off Metro now, just over half way through the course.

Has anyone else had this and can comment on what happened with the side effect?
Also the clinical study that I found on line only referred to the benefits of taking Metro if you start it a week after surgery. Does anyone have any experiences of taking it later (in my case almost 3 months after surgery) and how that worked for them?

 

[24601]

I was on metronidazole for 90 days after my surgery last August. I started 2 weeks after surgery (not sure why my doctors didn't start one week post-op as per the study). I also started back on Humira and methotrexate 2 weeks post-op so my doctor told me that the course of antibiotics would only reduce my chances of inflammation returning at the site of anastomosis by 10% - less of an effect than if I hadn't been on other meds.

I didn't have any side effects so completed the course of antibiotics. It wasn't a big part of my treatment but we felt every little gain was worthwhile.

The only study I know about is the one that started metronidazole 1 week post-op. Since ulcers can be seen within six weeks post-op, I'm not sure how much effect you starting metronidazole now will have for you.

Have you talked about other treatments? What kind of monitoring are you going to have to check on your (hopefully lack of) disease activity?

Good luck! Hope you have a long remission!

 

[Pigeon]

Thanks for your reply - very interesting. I'm with you in that I've only seen that one study on Metro, at least on Metro working alone and I'm not sure why I was put on it so late.

No other medication is on the cards immediately, although I may go back on aza at some stage. To be honest I'm reluctant as last year I was also diagnosed with breast cancer. Although I'm out the other side of all that treatment and am currently all clear, I have mixed feelings about taking an immune suppressant given that a strong immune system helps against cancer. Which disease do I fear most?! I'm also trying natural remedies to reduce inflammatory conditions in my body such as Omega 3 oil, vit D, slippery elm and aloe vera juice - hopefully helpful for both Crohns and cancer.

I was interested in your question on post-op monitoring. I've been trying to research what is usual for this too. Can't see anything helpful on the NICE guidelines etc. My consultant is talking vaguely about doing a colonoscopy maybe in 12 months? But studies indicate that the progress of disease can be best indicated by endoscopy (or maybe ultrasound) 6 months after surgery. Any views on what is best practice post-op monitoring?

 

[24601]

For my last two surgeries, we've done MRIs 3 months post-op which I believe my gastro team consider fairly standard.

I have small bowel disease only though so colonoscopy isn't done for me but I imagine they'd also repeat that as standard for anyone whose disease can be surveyed that way. I know there was a member on the forum who was part of a study where they are doing regular camera pills to monitor disease and that may well be increasingly used too - it's never been a choice for me because of strictures.

Have you previously shown raised inflammatory markers in bloods or stool? If they've been useful in the past then I would want to continue with regular testing of those as well. But as you know, when they scope people after surgery it's the ulcers that are seen before any other clinical findings.

I would push for a colonoscopy 6 months post-op. And if your consultant isn't up for that then I would change GIs.

It might be interesting to start a new thread about post-op monitoring to get a consensus on what forum members have experienced. I think it seems to be an opportunity that can too often be missed to keep this disease under control and prevent further damage. Too often best practice takes so long to filter through to actual practice for so many of us! I feel that we have to take note of the very best experiences of forum members to insist on similar care for ourselves!

Crohn's disease seems to go hand-in-hand with tough treatment decisions and it must be so much harder when you are considering another disease too.

I hope you have good luck with your anti-inflammatory treatments. There have been a couple of members who have dealt with skin cancer and Crohn's and had similar concerns about immunosuppression - the treatments suggested for them on the forum were enteral nutrition and diet (SCD, Paleo, IBD-AID etc). Perhaps anti-MAP antibiotic therapy would also be a possibility.

 

[Pigeon]

Thanks so much for all your input. I agree with the suggestion for a new thread about post-op monitoring. This is my first ever forum experience and not entirely sure how it works. Happy to set up a new thread if that would be appropriate?

And I haven't come across those other treatments you talk about so will research further and am also going to talk to my GP about second options for consultants.

The other decision I've taken today is to stop the Metronidazole. Yet another pain disturbed night with the joint pain now extending to my fingers have helped make that decision - although it wasn't taken lightly!

 

[24601]

I think it's completely understandable that you stopped the metronidazole since you were experiencing side effects and had started it so late after surgery.

I just had a look at this paper which does talk about deciding on treatment based on a scope 1 year post-op http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921499/

This paper talks about 6-12 months for a scope http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4188927/

This paper talks about stratifying patients by risk for post-op recurrence and perhaps their criteria would help you decide if you are at higher risk http://www.ncbi.nlm.nih.gov/pubmed/22969204

Yes, it's absolutely appropriate to start a new thread for post-op monitoring for recurrence. Feel free to start new threads when you have a new question or topic and if you'd like to introduce yourself in the "Your Story" section then that's a great place for people to come and say hello and welcome you to the forum If you have any other questions about how the forum works do ask - it's a great resource.