Highlight
- Antibiotic therapy induces rapid but transient remission in pouchitis by reducing exotoxin-producing bacteria.
- Antibiotic resistance gene abundance increases during treatment, driven by expansion of pre-existing resistant strains.
- Virulent bacterial strains re-emerge post-treatment, contributing to relapse of pouch inflammation.
- Long-term management requires targeted strategies beyond broad-spectrum antibiotics to achieve sustained microbial control.
