Argh! Flagyl making abscess worse??

Sorry for the inevitable TMI to follow. I've had a fistula/abscess since January (not sure which one it is - it's like a big, squishy painful lump on my perineum, worryingly near to my, um, lady parts but so far it only seems to drain via my butt, thank goodness, so I assume it hasn't yet managed to achieve its evil master plan of becoming a full-on rectovaginal fistula).

Two and a half weeks ago I started on 30mg of Prednisolone and the thing started to get smaller and hurt less. Actually, for about a week my whole bum area felt almost normal, which was amazing since I've had fissures and stuff for about five years. A week ago I started taking Azathioprine and dropped to 25mg of Pred, and early this week I tapered down to 20mg of Pred and started taking Flagyl/Metronizadole (800mg a day for a week), which my gastroenterologist prescribed me specifically for the fistula.

Weirdly, since early this week it's suddenly got worse? I've been having non-D poops for the first time in a long time, which was fine until Wednesday, when suddenly there was blood when I went to the loo but no pain. Today there's pain, and a LOT of blood, and the damn thing is back to its former squishy draining lump of a self. (And it really hurts, makes sitting difficult, not to mention being a complete bedroom buzzkill) Plus I feel like I have a fever - I don't own a thermometer so I can't check, but have been having night sweats and very hot flushes/shivers in the afternoon when everyone else in the room is completely the opposite temperature.

So... I don't know whether a) Flagyl is somehow making the fistula worse or b) Flagyl is doing absolutely nothing and it's just that I'm tapering off the Pred, which was helping. Anyone else had similar experiences?

Could be either honestly. 800 mg flagyl is pretty low, so I don't feel like that would be making it worse. You are not taking any other antibiotic correct? No cipro?

Flagyl is supposed to help fistulas drain, so as long as it's draining I would not panic. It might feel irritated befote it starts to get better. Sitting in a warm tub for 15 mins 2 or 3 times a day can help it to drain and might ease your pain. I've had these things for years I know how horrible they are. Using an ointment such as calmoseptine can provide relief especially if your skin is getting irritated in that area.

If you go a few more days and it's still really lumpy or hard or inflamed please see a doctor. Especially if you continue to run fever.

It's very unlikely that the flagyl is the problem... You should call your MD because your symptoms are worse. Prednisone can cause night sweats and hot flashes. I get them horrible when I'm on prednisone... It wouldn't be a bad idea to buy a thermometer though, fevers are an indicator of infection. You might want to talk to your MD about biologics. I have had crohns for 4 years and completely resisted the idea of biologics. I'm a nurse and taking a medication that can severely lower my immunity didn't seem like a great idea. Then over the summer I'd discovered an anal fistula, and it got infected along with a vaginal glad (not fun). I'm also an NP student at a medical university so I have great access to research (which I was quite obsessive about). I found that remicade had most success at fistula healing without surgical intervention, and more so in combination I'm imuran. Which is also what my. GI recommended. I only did the remicade and I have had my first three infusions... No pain, no drainage and it's getting smaller.
For symptom relief... Moist heat helps pull the puss or drainage out which will help relieve the pain. You can do warm packs or sit in the tub for 20 minutes 3 times a day. I used the tub with Epsom salt. I know this is really difficult, but bandage where your draining from, and change it frequently it will help wick away the moisture from your skin and wash the area with antibacterial soap.

I would be very wary of starting biologics if you have an active infection. Even though your GI will probably say it's fine.

Your absolutely right, it isn't recommended to start biologics if you have an infection. In patients with inflammatory bowel disease an abscess isn't always from infection, but the body is creating an immune response as if there was. That's why it's first recommended to start with a course of flagyl, so if it is infectious in nature, the antibiotics will be an effective treatment. The recommendation used to be flagyl and Cipro in combination, but they found that it was no more effective than flagyl alone.

Thank you for the information...at what point did they stop the cipro/flagyl combo for abscesses? As of last year all the GI's I talked to were still doing it.

I am glad to hear the remicade is working well for you.

The article was dated either 2009 or 2011, can't remember for sure... They can certainly use both, but it isn't more effective than flagyl alone...

Thank you both for the info, that's helpful... I've booked in to see my doctor on Monday since it's not getting any better and I'm supposed to stop the Flagyl on Tuesday, hopefully he can help! And yes, no Cipro prescribed for me.