From the Guidelines
The initial treatment for acute diverticulitis should be selective use of antibiotics, rather than routine use, in patients with uncomplicated diverticulitis, unless they have comorbidities, are frail, or present with refractory symptoms, vomiting, or signs of systemic inflammation, as recommended by the most recent guidelines 1. The approach to treating acute diverticulitis has evolved, with a focus on reducing unnecessary antibiotic use while ensuring appropriate treatment for those at higher risk of complications.
- For patients with uncomplicated diverticulitis who are immunocompetent and without signs of systemic inflammation, the use of antibiotics may not be necessary, as supported by recent evidence 1.
- However, patients with complicated diverticulitis, those who are immunocompromised, or those with signs of systemic inflammation (such as CRP >140 mg/L or baseline white blood cell count > 15 × 10^9 cells per liter) should be treated with antibiotics 1.
- The choice of antibiotic regimen should cover both gram-negative and anaerobic bacteria, with common regimens including a combination of an oral fluoroquinolone and metronidazole or monotherapy with oral amoxicillin-clavulanate 1.
- The duration of antibiotic treatment is typically 4–7 days but can be longer based on the patient's general health status, immune status, severity of presentation, CT findings, and patient expectations 1.
- In addition to antibiotic therapy, patients should follow a clear liquid diet initially, gradually advancing to a low-fiber diet as symptoms improve, and then transitioning to a high-fiber diet after resolution, along with appropriate pain management and hydration 1.
- For severe or complicated diverticulitis, hospitalization is necessary for intravenous antibiotics, bowel rest, and possibly surgical intervention, as these cases require more intensive management to prevent further complications and improve outcomes 1.
From the Research
Initial Treatment for Acute Diverticulitis
The initial treatment for acute diverticulitis typically involves conservative management, with the goal of resolving the infection and inflammation.
- For uncomplicated diverticulitis, treatment may include a clear liquid diet and antibiotics, such as ciprofloxacin and metronidazole 2, 3.
- Outpatient treatment with oral antibiotics is a viable option for selected patients with uncomplicated acute diverticulitis, with studies showing similar efficacy and safety to inpatient treatment with intravenous antibiotics 2, 3.
- Some patients with uncomplicated diverticulitis may not require antibiotics, and can be treated without bed rest or dietary restrictions 4.
Antibiotic Treatment
Antibiotic treatment is the treatment of choice for uncomplicated diverticulitis and can be performed for mild complicated diverticulitis.
- Antibiotics such as ciprofloxacin, metronidazole, and rifaximin have been successfully used in the treatment of uncomplicated diverticular disease 5, 6.
- The combination of mesalazine and an antibiotic has shown significant superiority in improving symptoms and preventing recurrence of diverticulitis compared to antibiotics alone 6.
Outpatient Treatment
Outpatient treatment for uncomplicated and mild complicated diverticulitis is feasible and safe, with a lower failure rate compared to inpatient treatment 5.