From the FDA Drug Label
Gastrointestinal Steroids should be used with caution in active or latent peptic ulcers, diverticulitis, fresh intestinal anastomoses, and nonspecific ulcerative colitis, since they may increase the risk of a perforation The use of steroids is not indicated for the treatment of diverticulitis due to the increased risk of perforation. Steroids should be used with caution in patients with diverticulitis, as they may exacerbate the condition 1, 1.
- Key points:
- Steroids may increase the risk of perforation in diverticulitis
- Use with caution in active or latent peptic ulcers, diverticulitis, fresh intestinal anastomoses, and nonspecific ulcerative colitis
- Risk of perforation is a significant concern when using steroids in diverticulitis
From the Research
Steroids are not indicated for the treatment of diverticulitis. The standard treatment for uncomplicated diverticulitis typically includes antibiotics such as metronidazole (500 mg three times daily) combined with ciprofloxacin (500 mg twice daily) or amoxicillin-clavulanate (875/125 mg twice daily) for 7-10 days, along with bowel rest and pain management. For mild cases, outpatient management is appropriate, while more severe cases may require hospitalization for intravenous antibiotics and possibly surgical intervention. Steroids, which are anti-inflammatory medications like prednisone or dexamethasone, are not recommended as they can mask symptoms of worsening infection and potentially increase the risk of perforation or other complications. Additionally, steroids can impair immune function, which could be detrimental when fighting an active infection like diverticulitis. The goal of treatment is to reduce inflammation and infection in the diverticula (small pouches in the colon wall) without compromising the body's ability to heal properly, which steroids might interfere with.
The most recent and highest quality study, 2, suggests that the effect of antibiotics is uncertain for complications, emergency surgery, recurrence, elective colonic resections, and long-term complications, with low-certainty evidence. However, this study does not support the use of steroids in the treatment of diverticulitis. Other studies, such as 3 and 4, also support the use of antibiotics and outpatient management for uncomplicated diverticulitis, but do not mention the use of steroids.
Key points to consider in the treatment of diverticulitis include:
- The use of antibiotics, such as metronidazole and ciprofloxacin, for 7-10 days
- Bowel rest and pain management
- Outpatient management for mild cases and hospitalization for more severe cases
- The potential risks of steroids, including masking symptoms of worsening infection and impairing immune function
- The goal of treatment is to reduce inflammation and infection without compromising the body's ability to heal properly.
Overall, the evidence suggests that steroids are not a recommended treatment for diverticulitis, and that antibiotics and supportive care are the preferred treatment options.