From the Guidelines
Treatment for diverticulitis should be individualized based on the severity of the condition, with a focus on selective use of antibiotics, dietary modifications, and lifestyle changes to reduce the risk of recurrence and promote healthy bowel function. The approach to treating diverticulitis depends on several factors, including the severity of symptoms, the presence of complications, and the patient's overall health status.
- For mild cases, outpatient management with a clear liquid diet, gradual advancement to a low-fiber diet, and selective use of antibiotics such as ciprofloxacin and metronidazole may be sufficient 1.
- Severe cases, or those with complications such as abscesses, perforation, or obstruction, may require hospitalization for intravenous antibiotics, bowel rest, and other supportive measures 1.
- Patients with immunosuppression, or those with a history of recurrent diverticulitis, may benefit from a more aggressive approach, including elective segmental resection 1. Some key considerations in the management of diverticulitis include:
- The use of antibiotics should be selective, rather than routine, in patients with acute uncomplicated diverticulitis, as the evidence suggests that there is no benefit in immunocompetent patients with mild disease 1.
- Dietary modifications, such as a high-fiber diet, can help reduce the risk of recurrence and promote healthy bowel function 1.
- Lifestyle changes, such as regular exercise, maintaining a healthy weight, and avoiding smoking, can also help reduce the risk of recurrence and promote overall health 1. Overall, the goal of treatment for diverticulitis is to manage symptoms, prevent complications, and reduce the risk of recurrence, while also promoting healthy bowel function and overall health. The most recent and highest quality study, published in 2022, provides guidance on the diagnosis and management of acute left-sided colonic diverticulitis, and recommends a selective approach to the use of antibiotics, as well as outpatient management for most patients with uncomplicated diverticulitis 1.
From the Research
Treatment Overview
- The treatment for diverticulitis typically involves a combination of medical and dietary approaches, with the goal of managing symptoms, resolving inflammation, and preventing complications 2, 3, 4, 5, 6.
- For uncomplicated diverticulitis, outpatient treatment with oral antibiotics, a liquid diet, and oral analgesics has been shown to be safe and effective in resolving inflammation and preventing complications 2, 4, 6.
Medical Treatment
- Antibiotics are a key component of diverticulitis treatment, with common regimens including metronidazole, ciprofloxacin, and ampicillin 3, 4, 5.
- The choice of antibiotic and treatment duration may vary depending on the severity of the condition and the presence of any complications 3, 5.
- In some cases, mesalazine and probiotics may be used in conjunction with antibiotics to improve symptoms and prevent recurrence 3.
Dietary Treatment
- A clear liquid diet is often recommended for the initial treatment of diverticulitis, with the goal of putting the intestine "at rest" and reducing inflammation 2, 4, 6.
- As symptoms improve, patients may gradually transition to a solid food diet, with a focus on high-fiber foods to help prevent future episodes of diverticulitis 3.
Outpatient vs. Inpatient Treatment
- Outpatient treatment has been shown to be a viable option for patients with uncomplicated diverticulitis, with success rates of over 90% reported in some studies 2, 4, 6.
- Inpatient treatment may be necessary for patients with severe or complicated diverticulitis, or for those who require closer monitoring and support 5.
- The choice between outpatient and inpatient treatment should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances 5.