Dubinsky V, Reshef L, Bar N, et al. - Among 49 pouchitis individuals who had undergone pouch surgery at a tertiary center in Israel, researchers sought to examine microbial factors correlated with response to antibiotic treatment and development of antibiotic dependence. Based on clinical, endoscopic, and histologic criteria, disease activity has been determined. They defined pouch phenotype as recurrent-acute pouchitis (n = 6), chronic pouchitis and Crohn's-like disease of the pouch (n = 27), normal pouch from patient with ulcerative colitis (n = 10), and normal pouch from patient with familial adenomatous polyposis (n = 6). According to this prospective study, most antibiotic-treated individuals (79%) had a clinical response to each course of antibiotics, however, 89% of those who finished a 4-week course relapsed within 3 months. Treatment with antibiotics decreased disease-associated bacteria like Clostridium perfringens, Ruminococcus gnavus, and Klebsiella pneumoniae, but also beneficial species, such as Faecalibacterium prausnitzii. Findings suggested that the efficacy of pouchitis antibiotic treatment could be due to the development of a low inflammatory potential antibiotic-resistant microbiome. This microbiome could provide resistance by bacteria that promote inflammation against colonization. Strategies like short-term alternating antibiotics and nutrition- and microbiome-based interventions should be considered in order to avoid progression to antibiotic-dependent disease and its consequences.