From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
For diverticulitis treatment, the recommended antibiotic regimen is ceftriaxone and metronidazole, as it has been found to be non-inferior to piperacillin/tazobactam in treating complicated diverticulitis, according to the most recent study published in 2025 1.
Key Considerations
- The optimal antibiotic regimen for diverticulitis has not been well established in guidelines, but recent studies suggest that ceftriaxone and metronidazole may be a suitable option.
- A 5-year retrospective cohort study found that ceftriaxone and metronidazole was non-inferior to piperacillin/tazobactam for the combined primary outcome of 30-day readmission or all-cause mortality 1.
- Patients who received oral antibiotic therapy in the 7 days prior to admission were found to have increased risk of mortality or readmission and antibiotic failure 1.
Treatment Recommendations
- For patients with complicated diverticulitis, ceftriaxone and metronidazole may be considered as an empirical treatment option.
- Ensure adequate hydration during treatment and take metronidazole with food to minimize gastrointestinal side effects.
- Patients should avoid alcohol while taking metronidazole and for 48 hours afterward due to potential disulfiram-like reactions.
- If symptoms worsen (increased pain, fever, inability to tolerate oral intake), prompt medical reevaluation is necessary as intravenous antibiotics or hospitalization may be required.
Rationale
- The most recent study published in 2025 1 provides the highest quality evidence for the treatment of diverticulitis, and its findings support the use of ceftriaxone and metronidazole as a non-inferior option to piperacillin/tazobactam.
- The study's results are consistent with the goal of minimizing morbidity, mortality, and improving quality of life for patients with diverticulitis.