What is the treatment for diverticulitis?

From the Guidelines

Treatment for diverticulitis typically involves selective use of antibiotics, with consideration of patient-specific factors and disease severity.

Key Considerations

• 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.
• Broad-spectrum antibiotics with gram-negative and anaerobic coverage are usually recommended, such as a combination of an oral fluoroquinolone and metronidazole or monotherapy with oral amoxicillin-clavulanate 1.
• Duration of treatment is typically 4-7 days, but can be longer based on individual patient factors, such as general health status, immune status, severity of presentation, and CT findings 1.

Special Considerations

• Colonoscopy may be recommended after an initial episode of complicated left-sided colonic diverticulitis in patients who have not had a recent colonoscopy, to rule out colorectal cancer or advanced colonic neoplasia 1.
• Elective surgery may be considered to prevent recurrent diverticulitis in patients with persistent or frequently recurring uncomplicated diverticulitis, or complicated diverticulitis, after discussing potential benefits, harms, costs, and patient preferences 1.
• Mesalamine is not recommended to prevent recurrent diverticulitis, due to lack of evidence showing benefit and potential harms 1.

From the Research

Treatment Options for Diverticulitis

The treatment for diverticulitis can vary depending on the severity of the condition and the individual patient's needs. Some of the treatment options include:

• Outpatient treatment for uncomplicated diverticulitis in patients without associated comorbidities 2
• Conservative treatment, including bowel rest and intravenous antibiotics, for uncomplicated acute diverticulitis 3
• Non-operative management, including percutaneous drainage, for small abscesses 3
• Surgical intervention, including Hartmann procedure or primary anastomosis, for peritonitis or failure of non-operative management 3
• Elective surgery, including laparoscopic approach, for chronic, smoldering, or recurrent forms of diverticulitis 2, 4

Medical Management

Medical management of diverticulitis includes:

• Antibiotics, which may be omitted in mild cases 4
• Supportive measures, such as bowel rest and pain management 3
• Interval colonoscopy, which is recommended after an acute attack, particularly after a complicated form 4

Surgical Management

Surgical management of diverticulitis includes:

• Resection of diseased bowel to healthy proximal colon and rectal margins 5
• Operative approaches, such as loop colostomy, sigmoidectomy with colostomy (Hartmann’s procedure), and sigmoidectomy with primary colorectal anastomosis 5
• Laparoscopic lavage, which is a novel treatment modality for complicated diverticulitis 5

Patient Selection and Management

Patient selection and management are crucial in the treatment of diverticulitis. Factors to consider include:

• Patient age, comorbidities, nutritional state, and severity of disease 5
• Surgeon preference and experience 5
• Optimization of patient risk factors and tailoring the surgical approach and perioperative management 5