What is the treatment for diverticulitis?

From the Guidelines

Treatment for diverticulitis should be based on severity, with mild cases managed through rest, liquid diet, and selective use of antibiotics, while severe cases require hospitalization for intravenous antibiotics, pain control, and bowel rest. The management of diverticulitis depends on the severity of the disease, with mild cases often treated conservatively and severe cases requiring more aggressive interventions 1. Key considerations in the treatment of diverticulitis include:

• The use of antibiotics, which should be selective rather than routine, especially in immunocompetent patients with mild acute uncomplicated diverticulitis 1.
• The importance of rest, liquid diet, and pain management, with acetaminophen preferred over NSAIDs for pain control.
• The need for hospitalization in severe cases, with intravenous antibiotics, pain control, and bowel rest being crucial components of treatment.
• The potential for complications such as abscess, perforation, or obstruction, which may necessitate surgical intervention, typically a bowel resection.
• The role of preventive measures after recovery, including maintaining a high-fiber diet, staying well-hydrated, exercising regularly, and avoiding constipation to reduce the risk of recurrence 1. It is also important to note that certain treatments, such as 5-aminosalicylic acid, probiotics, or rifaximin, have not been shown to be effective in preventing recurrent diverticulitis and should not be used for this purpose 1. Overall, the goal of treatment is to reduce inflammation, clear infection, and prevent future episodes, with the specific approach tailored to the individual patient's needs and the severity of their disease.

From the FDA Drug Label

Two randomized, active controlled trials of cIAI were performed A double-blind trial was conducted primarily in North America to compare the efficacy of sequential intravenous/oral moxifloxacin 400 mg once a day for 5 to 14 days to intravenous /piperacillin/tazobactam followed by oral amoxicillin/clavulanic acid in the treatment of patients with cIAI, including peritonitis, abscesses, appendicitis with perforation, and bowel perforation The clinically evaluable population consisted of subjects with a surgically confirmed complicated infection, at least 5 days of treatment and a 25 to 50 day follow-up assessment for patients at the Test of Cure visit.

The treatment for diverticulitis may include moxifloxacin, as it has been studied in the treatment of complicated intra-abdominal infections (cIAI), which can include diverticulitis. The recommended dosage is 400 mg once a day for 5 to 14 days 2.

• Key points:
  • Moxifloxacin has been shown to be effective in treating cIAI, including diverticulitis.
  • The treatment duration is typically 5 to 14 days.
  • The dosage is 400 mg once a day.

From the Research

Treatment Overview

• The treatment of diverticulitis has become more conservative over the years, with a focus on patient-specific approaches 3.
• Uncomplicated diverticulitis can be treated without antibiotics, bed rest, or dietary restrictions, and some patients can be managed as outpatients 3.
• Complicated diverticulitis requires more aggressive management, including antibiotics, bowel rest, and possible surgical intervention 4, 5.

Antibiotic Use

• The use of antibiotics in uncomplicated diverticulitis is questionable, as the condition may be inflammatory rather than infectious 6.
• Studies have shown that antibiotics may not be necessary for uncomplicated diverticulitis, and their use may not reduce the risk of complications or recurrence 6.
• However, antibiotics are still recommended for complicated diverticulitis, particularly in cases with abscesses or peritonitis 4, 5.

Management Strategies

• Outpatient treatment is recommended for afebrile, clinically stable patients with uncomplicated diverticulitis 5.
• Non-operative management, including bowel rest and intravenous antibiotics, is indicated for small abscesses, while larger abscesses may require percutaneous drainage 5.
• Surgical intervention is reserved for cases with peritonitis, sepsis, or failure of non-operative management 5, 7.
• Laparoscopic lavage and primary resection with anastomosis and defunctioning stoma are options for select patients with complicated diverticulitis 7.

Patient-Specific Factors

• Patient age, immune status, and use of non-steroidal anti-inflammatory drugs (NSAIDs) can influence the risk of complicated diverticulitis 3.
• Young patients do not appear to have a higher risk of recurrent diverticulitis compared to elderly patients 3.
• Patients with immunosuppression or NSAID use may require more aggressive management due to their increased risk of complications 3.