What is the treatment for acute diverticulitis?

From the Guidelines

The treatment for acute diverticulitis should prioritize outpatient management for mild cases, with the use of antibiotics such as amoxicillin-clavulanate or a combination of ciprofloxacin and metronidazole for 7-10 days, and dietary modifications to reduce pressure in the colon and prevent recurrence, as supported by the most recent and highest quality study 1.

Key Considerations

• The severity of the condition determines the treatment approach, with mild cases managed outpatient and severe cases requiring hospitalization.
• Antibiotics are effective in treating diverticulitis, but their use should be selective, especially in immunocompetent patients with mild acute uncomplicated diverticulitis, as suggested by recent evidence 1.
• Dietary modifications, including a clear liquid diet initially, followed by a low-fiber diet, and eventually a high-fiber diet, help reduce pressure in the colon and prevent recurrence.
• Pain management with acetaminophen or non-steroidal anti-inflammatory drugs is recommended.
• Complications like abscesses may require percutaneous drainage, while perforation, obstruction, or fistulas often necessitate surgical intervention.

Antibiotic Therapy

• The choice of antibiotic regimen should depend on the severity of infection, the pathogens presumed to be involved, and the risk factors indicative of major resistance patterns, as recommended by the WSES guidelines 1.
• A 4-day period of postoperative antibiotic therapy is suggested in complicated ALCD if source control has been adequate, as supported by moderate-quality evidence 1.

Outpatient Management

• Outpatient management is safe and effective in selected patients with uncomplicated acute diverticulitis, with a failure rate of 4.3% (95% CI 2.6–6.3%), as reported in a systematic review 1.
• The DIVER trial demonstrated that outpatient treatment may be safe and effective in selected patients with uncomplicated acute diverticulitis, reducing healthcare costs without negatively influencing quality of life 1.

From the Research

Treatment Overview

The treatment for acute diverticulitis can vary depending on the severity of the condition.

• For uncomplicated diverticulitis, treatment typically involves a clear liquid diet and antibiotics 2, 3.
• In some cases, outpatient treatment with oral antibiotics may be sufficient, with studies showing that this approach can be safe and effective for most patients with uncomplicated acute diverticulitis 2, 3, 4.
• However, hospitalization may be necessary for patients with signs of peritonitis or suspected complicated diverticulitis 5.

Complicated Diverticulitis

For complicated diverticulitis, treatment may involve:

• Intravenous antibiotics and fluid resuscitation 5.
• Computed tomography-guided percutaneous drainage for patients with a localized abscess 5.
• Surgical intervention, which may be necessary for 15-30% of patients admitted with acute diverticulitis 5.
• Laparoscopic surgery, which can result in a shorter length of stay, fewer complications, and lower in-hospital mortality compared to open colectomy 5, 6.

Predictors of Treatment Failure

Studies have identified certain factors that may increase the risk of treatment failure, including:

• Female sex 4.
• Presence of free fluid on CT scan 4.
• These factors can help guide treatment decisions and identify patients who may require closer monitoring or more aggressive treatment.

Prevention of Recurrences

To prevent recurrences of diverticulitis, interventions such as:

• Increased intake of dietary fiber 5.
• Exercise 5.
• Cessation of smoking 5.
• Weight loss for individuals with a body mass index of 30 kg/m² or higher 5 may be recommended.