What is the best treatment approach for a patient with diverticulitis and active arthrosis in the feet, presenting with elevated C-Reactive Protein (CRP)?

From the Guidelines

The best treatment approach for a patient with diverticulitis and active arthrosis in the feet, presenting with elevated C-Reactive Protein (CRP), is to start with broad-spectrum antibiotics such as ciprofloxacin 500mg twice daily plus metronidazole 500mg three times daily for 7-10 days, given the patient's elevated CRP and potential for complications 1. For the diverticulitis, this antibiotic regimen is advised due to the presence of comorbidities (active arthrosis) and elevated CRP, which may indicate a higher risk of complications 1. The patient should maintain a clear liquid diet initially, gradually advancing to low-fiber foods as symptoms improve. For pain management, it is recommended to use acetaminophen (up to 3000mg daily in divided doses) rather than NSAIDs, as NSAIDs may exacerbate gastrointestinal inflammation and potentially worsen diverticulitis. The elevated CRP indicates active inflammation, likely from both conditions, and should decrease with appropriate treatment. For the foot arthrosis, consider topical analgesics like diclofenac gel 1% applied to affected joints 4 times daily, along with physical therapy and appropriate footwear with orthotic support. Weight management is also important as it reduces pressure on both the colon and feet joints. This combined approach addresses the infectious/inflammatory process of diverticulitis while managing arthrosis pain without compromising gastrointestinal healing. Regular monitoring of CRP levels will help assess treatment effectiveness for both conditions. Key considerations include:

• The risk of progression to complicated diverticulitis is higher in patients with elevated CRP (>140 mg/L) or baseline white blood cell count > 15 × 10^9 cells per liter 1
• Antibiotic treatment is advised in patients with uncomplicated diverticulitis who have comorbidities or are frail, who present with refractory symptoms or vomiting, or who have a CRP >140 mg/L or baseline white blood cell count > 15 × 10^9 cells per liter 1.

From the Research

Treatment Approach for Diverticulitis with Active Arthrosis in Feet and Elevated CRP

• The treatment approach for a patient with diverticulitis and active arthrosis in the feet, presenting with elevated C-Reactive Protein (CRP), should be based on the classification of diverticulitis as complicated or uncomplicated 2.
• For uncomplicated diverticulitis, outpatient treatment is recommended in afebrile, clinically stable patients, and antibiotics have no proven benefit in reducing the duration of the disease or preventing recurrence, and should only be used selectively 2, 3.
• The use of antibiotics for uncomplicated diverticulitis is uncertain, and the evidence suggests that the effect of antibiotics is uncertain for complications, emergency surgery, recurrence, elective colonic resections, and long-term complications 3.
• For complicated diverticulitis, non-operative management, including bowel rest and intravenous antibiotics, is indicated for small abscesses, and larger abscesses should be drained percutaneously 2.
• Elevated CRP levels can be a useful biomarker for complicated diverticulitis, with a level of >90 mg/ml having 88% sensitivity and 75% specificity for complicated disease 4.
• However, the use of anti-inflammatory medications such as aspirin and corticosteroids can affect CRP levels, and the difference in mean CRP levels for complicated and uncomplicated disease was not statistically significant in patients on corticosteroid treatment 4.
• The treatment approach should also take into account the patient's active arthrosis in the feet, and the potential impact of diverticulitis treatment on this condition.
• Amoxicillin-clavulanate may be a suitable antibiotic option for outpatient diverticulitis, as it may reduce the risk of fluoroquinolone-related harms without adversely affecting diverticulitis-specific outcomes 5.