What is the treatment for acute diverticulitis?

From the Guidelines

Acute diverticulitis treatment should prioritize a selective approach to antibiotic use, with antibiotics reserved for patients with complicated diverticulitis, systemic inflammatory response, or high-risk features, while mild cases may be managed without antibiotics, focusing on pain management and dietary modifications. The management of acute diverticulitis has evolved, with recent guidelines suggesting a more conservative approach to antibiotic use 1. For immunocompetent patients with uncomplicated acute diverticulitis, the current evidence supports withholding antibiotic therapy, as it does not accelerate recovery or prevent complications 1. Key considerations in the management of acute diverticulitis include:

• Patient selection for outpatient versus inpatient management, with outpatient management being suitable for most patients with uncomplicated diverticulitis who can tolerate oral intake and have adequate social support 1.
• The use of antibiotics should be guided by the presence of complications, systemic inflammatory response, or high-risk features, rather than being routinely administered for all cases of diverticulitis 1.
• Dietary modifications, including a clear liquid diet initially, followed by a gradual advancement to a low-fiber diet, and eventually a high-fiber diet after recovery, are recommended to reduce intestinal work and prevent further irritation of the inflamed areas 1.
• Pain management with acetaminophen or non-steroidal anti-inflammatory drugs is also an essential component of treatment 1. The American College of Physicians guideline recommends that clinicians use abdominal CT imaging when there is diagnostic uncertainty in a patient with suspected acute left-sided colonic diverticulitis, and suggests managing most patients with acute uncomplicated left-sided colonic diverticulitis in an outpatient setting 1. Overall, the treatment of acute diverticulitis should be individualized, taking into account the severity of the disease, the presence of complications, and the patient's overall health status, with a focus on minimizing antibiotic use and promoting a high-fiber diet and adequate hydration to prevent recurrence 1.

From the Research

Acute Diverticulitis Treatment

• The treatment of acute diverticulitis depends on the severity of the disease, with uncomplicated cases often managed outpatient and complicated cases requiring hospitalization 2, 3.
• For patients with uncomplicated diverticulitis, antibiotics have no proven benefit in reducing the duration of the disease or preventing recurrence, and should only be used selectively 4, 5.
• Outpatient treatment with oral antibiotics is safe and effective for patients with uncomplicated acute diverticulitis who are able to tolerate oral intake and have adequate family support 3.
• Inpatient management includes intravenous fluid resuscitation and intravenous antibiotics, and is necessary for patients with complicated diverticulitis or those who are unable to tolerate oral intake 2, 6.
• Surgical intervention may be necessary for patients with peritonitis, sepsis, or failure of non-operative management, and can be performed using either an open or laparoscopic approach 2, 5.

Treatment Options

• Antibiotics: may be used to treat uncomplicated diverticulitis, but have no proven benefit in reducing the duration of the disease or preventing recurrence 4, 5.
• Intravenous antibiotics: necessary for patients with complicated diverticulitis or those who are unable to tolerate oral intake 2, 6.
• Bowel rest: may be recommended for patients with uncomplicated diverticulitis to reduce symptoms and promote healing 5.
• Percutaneous drainage: may be used to treat abscesses associated with diverticulitis 2, 5.
• Surgery: may be necessary for patients with peritonitis, sepsis, or failure of non-operative management 2, 5.

Prevention of Recurrences

• Increased intake of dietary fiber: may help to prevent recurrences of diverticulitis 2.
• Exercise: may help to prevent recurrences of diverticulitis 2.
• Cessation of smoking: may help to prevent recurrences of diverticulitis 2.
• Weight loss: may be recommended for patients with a body mass index of 30 kg/m2 or higher to help prevent recurrences of diverticulitis 2.