What is the treatment for diverticulitis (inflammation of the diverticula)?

From the Guidelines

Treatment for diverticulitis should be based on the severity of the condition, with mild cases managed with rest, liquid diet, and gradual reintroduction of solid foods, while severe cases may require hospitalization and intravenous antibiotics. For mild cases, home treatment with rest, liquid diet for a few days, and gradual reintroduction of solid foods as symptoms improve is recommended.

• Antibiotics are not necessary for immunocompetent patients with uncomplicated acute diverticulitis, as they do not accelerate recovery or prevent complications or recurrence 1.
• However, antibiotics may be prescribed for patients with complicated diverticulitis or those with signs of systemic inflammation.
• Pain management with acetaminophen is preferred over NSAIDs, which may irritate the digestive tract.
• Severe cases requiring hospitalization need intravenous antibiotics, bowel rest (nothing by mouth), and possibly surgical intervention if complications like perforation, abscess, or obstruction occur.
• After recovery, a high-fiber diet (25-30g daily) with adequate fluid intake helps prevent recurrence by promoting regular bowel movements and reducing pressure in the colon.
• Regular exercise and maintaining a healthy weight also contribute to prevention. Some key considerations for treatment include:
• The use of abdominal CT imaging to diagnose acute left-sided colonic diverticulitis when there is diagnostic uncertainty 1.
• The management of most patients with acute uncomplicated left-sided colonic diverticulitis in an outpatient setting 1.
• The initial management of select patients with acute uncomplicated left-sided colonic diverticulitis without antibiotics 1.

From the Research

Treatment Options for Diverticulitis

• The treatment for diverticulitis can be categorized into uncomplicated and complicated diverticulitis 2.
• For uncomplicated diverticulitis, outpatient treatment is recommended in afebrile, clinically stable patients 2.
• Antibiotics have no proven benefit in reducing the duration of the disease or preventing recurrence in uncomplicated diverticulitis, and should only be used selectively 2, 3.
• For complicated diverticulitis, non-operative management, including bowel rest and intravenous antibiotics, is indicated for small abscesses 2.
• Larger abscesses of 3-5 cm should be drained percutaneously, and patients with peritonitis and sepsis should receive fluid resuscitation, rapid antibiotic administration, and urgent surgery 2.

Antibiotic Treatment

• The use of antibiotics in uncomplicated diverticulitis is uncertain, with some studies suggesting no benefit in reducing complications or emergency surgery 3.
• Rifaximin has been shown to be effective in obtaining symptom relief and improving symptoms in patients with uncomplicated diverticular disease 4.
• Ceftriaxone and metronidazole has been found to be non-inferior to piperacillin/tazobactam for treating complicated diverticulitis 5.

Outpatient Treatment

• Outpatient treatment with oral antibiotics has been shown to be safe and effective in patients with uncomplicated acute diverticulitis who are able to tolerate oral intake and have adequate family support 6.
• Patients with uncomplicated diverticulitis who are treated as outpatients should be seen again at 4-7 days after starting treatment to confirm symptom improvement 6.

Surgical Intervention

• Surgical intervention is indicated for peritonitis or in failure of non-operative management 2.
• Colonoscopy is recommended for all patients with complicated diverticulitis 6 weeks after CT diagnosis of inflammation, and for patients with uncomplicated diverticulitis who have suspicious features on CT scan or who otherwise meet national bowel cancer screening criteria 2.