Does oral ciprofloxacin therapy for pouchitis increase the frequency of E. coli gyrA and parC mutations associated with quinolone resistance

What is known

- Study of 51 stool samples from 43 UC/IPAA patients (13 ciprofloxacin-treated, 30 untreated) quantified mutations at gyrA 83/87 and parC 80/84. ¹ - Paired samples before and just after starting ciprofloxacin showed increasing mutation rates at gyrA 83/87 and parC 84. ¹ - Fecal and mucosal biopsy mutation rates correlated, suggesting similar mutations in mucosa-associated bacteria. ¹

What is unknown / caveats

- Single small study; treated group was mainly chronic pouchitis on long-term ciprofloxacin (mean 13.9 months) - Study did not directly test whether ciprofloxacin caused loss of growth inhibition in mutant E. coli strains - Whether E. coli itself drives pouchitis pathology is uncertain; it was chosen because the mutation-resistance link is well characterized in E. coli.

## References

1. Fukushima K, Saito T, Kohyama A, Watanabe K. Increased Quinolone-Resistant Mutations of gyrA and parC Genes after Pouchitis Treatment with Ciprofloxacin. Dig Surg. 2020;37:321-330. PMID: 32182609.

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