From the Guidelines
The management of acute diverticulitis in a hospitalized setting primarily involves selective use of intravenous antibiotics, bowel rest, and supportive care, with antibiotics reserved for patients with complicated diverticulitis, immunocompromised patients, or those with signs of systemic inflammation, as recommended by the most recent guidelines 1. The approach to managing acute diverticulitis has evolved, with a focus on selective antibiotic use to minimize unnecessary antibiotic exposure and reduce the risk of antibiotic resistance.
- For uncomplicated diverticulitis, antibiotics may not be necessary in immunocompetent patients without signs of systemic inflammation, as supported by recent studies 1.
- However, for patients with complicated diverticulitis, such as those with abscess, perforation, or peritonitis, broad-spectrum IV antibiotics are recommended, with regimens including ceftriaxone plus metronidazole, piperacillin-tazobactam, ertapenem, or a fluoroquinolone plus metronidazole 1.
- Patients should initially receive nothing by mouth (NPO) and gradually advance to clear liquids and then a low-residue diet as symptoms improve, with pain management and IV fluids provided as needed.
- Clinical improvement typically occurs within 2-4 days, at which point transition to oral antibiotics can be considered to complete a 7-10 day total course.
- The management approach should be individualized based on the patient's clinical condition, with consideration of factors such as disease severity, comorbidities, and risk of complications 1.
From the Research
Management of Acute Diverticulitis
The management of acute diverticulitis, particularly in a hospitalized setting, involves the use of intravenous (IV) antibiotics to treat the infection and inflammation associated with diverticula.
- The therapeutic measures aim at putting the intestine 'at rest', thus resolving the infection, the consequences of the inflammation and preventing or limiting complications 2.
- For patients with severe and complicated diverticulitis, antibiotics such as ampicillin, gentamicin, metronidazole, piperacillin, and tazobactam are successfully used in clinical practice 2.
- In cases of uncomplicated diverticulitis, outpatient treatment with oral antibiotics such as metronidazole and ciprofloxacin has been shown to be effective and safe, with similar outcomes to inpatient treatment with IV antibiotics 3.
Antibiotic Treatment
The use of antibiotics in the treatment of acute diverticulitis is a topic of ongoing debate, with some studies suggesting that antibiotics may not be necessary for uncomplicated cases 4.
- A systematic review of randomized controlled trials found that the effect of antibiotics on complications, emergency surgery, recurrence, and long-term complications is uncertain, with low-certainty evidence 4.
- Another study found that outpatient treatment with oral antibiotics is viable in almost 95% of patients with uncomplicated acute diverticulitis, with no significant differences in outcomes compared to inpatient treatment with IV antibiotics 3.
- The choice of antibiotic regimen should be based on the severity of the disease, the patient's overall health, and the presence of any underlying conditions, with careful consideration of the potential benefits and risks of antibiotic treatment 5.
Hospitalized Setting
In a hospitalized setting, the management of acute diverticulitis typically involves the use of IV antibiotics, with the goal of resolving the infection and preventing complications.
- The selection of specific antimicrobial agents should be based on the suspected or confirmed pathogens involved, as well as the patient's individual needs and medical history 5.
- Careful monitoring of the patient's condition and adjustment of the treatment plan as needed are crucial to ensure optimal outcomes 2, 6.