What is the treatment for diverticulitis?

From the Guidelines

Treatment for diverticulitis should be based on the severity of the condition, with mild cases managed outpatient and severe cases requiring hospitalization. For mild cases, outpatient management may include oral antibiotics, such as ciprofloxacin (500mg twice daily) plus metronidazole (500mg three times daily) for 7-10 days, along with a liquid or low-fiber diet until symptoms improve 1. However, recent evidence suggests that antibiotics may not be necessary for all patients with uncomplicated diverticulitis, and their use should be selective, particularly in immunocompetent patients with mild disease 1. Pain management with acetaminophen or, if necessary, prescription pain medications may be recommended. Patients should gradually transition back to a high-fiber diet after symptoms resolve to prevent recurrence. Some key points to consider in the management of diverticulitis include:

• The use of antibiotics should be based on the severity of the disease and the presence of complications, such as abscess or perforation 1.
• Hospitalization is required for severe diverticulitis or cases with complications, where intravenous antibiotics, bowel rest, and possibly surgical intervention may be necessary 1.
• Long-term management focuses on prevention through a high-fiber diet (25-30g daily), adequate hydration, regular exercise, and maintaining healthy bowel habits 1.
• The treatment approach may vary depending on the patient's individual circumstances, such as the presence of comorbidities or immunosuppression 1. Overall, the goal of treatment is to reduce inflammation, control infection, and prevent complications while allowing the intestinal tissue to heal.

From the Research

Treatment Options for Diverticulitis

• The treatment for diverticulitis can be classified into two main categories: uncomplicated and complicated diverticulitis 2.
• For uncomplicated diverticulitis, outpatient treatment is recommended for afebrile, clinically stable patients 2, 3.
• Antibiotics have no proven benefit in reducing the duration of the disease or preventing recurrence in patients with uncomplicated diverticulitis, and should only be used selectively 2, 4, 5.

Complicated Diverticulitis Treatment

• 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 2.
• Patients with peritonitis and sepsis should receive fluid resuscitation, rapid antibiotic administration, and urgent surgery 2.
• Surgical intervention with either Hartmann procedure or primary anastomosis, with or without diverting loop ileostomy, is indicated for peritonitis or in failure of non-operative management 2.

Antibiotic Treatment

• The use of antibiotics in uncomplicated diverticulitis is uncertain, and more trials are needed to obtain precise effect estimates 5.
• Ceftriaxone and metronidazole has been found to be non-inferior to piperacillin/tazobactam for treating complicated diverticulitis 6.
• 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 6.

Follow-up and Colonoscopy

• 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.