What is the appropriate treatment for diverticulitis?

From the Guidelines

The most appropriate treatment for diverticulitis is selective use of antibiotics, with outpatient management for mild cases and hospitalization for severe cases, prioritizing patient values and preferences, and considering costs and benefits. The treatment approach should be based on the severity of the condition, with consideration of the patient's overall health status, immune status, and presence of complications. For mild cases, outpatient management may include oral antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily) or a combination of ciprofloxacin (500 mg twice daily) and metronidazole (500 mg three times daily) for 7-10 days, as well as a clear liquid diet initially, gradually advancing to a low-fiber diet as symptoms improve, then transitioning to a high-fiber diet after recovery to prevent recurrence 1. Pain management with acetaminophen or, if necessary, non-steroidal anti-inflammatory drugs is recommended. For severe cases requiring hospitalization, treatment includes intravenous antibiotics (such as ceftriaxone 1-2g daily plus metronidazole 500 mg every 8 hours), bowel rest (nothing by mouth), and IV fluids. Complications like abscesses may require percutaneous drainage, while perforation, obstruction, or fistulas often necessitate surgical intervention, with the goal of minimizing morbidity, mortality, and improving quality of life 1. The American College of Physicians (ACP) suggests that clinicians manage most patients with acute uncomplicated left-sided colonic diverticulitis in an outpatient setting, and initially manage select patients with acute uncomplicated left-sided colonic diverticulitis without antibiotics, taking into account the patient's individual circumstances and the potential risks and benefits of treatment 1. It is essential to consider the patient's values and preferences, as well as the potential costs and benefits of different treatment approaches, to provide personalized and effective care. In cases where antibiotic treatment is necessary, the regimen usually includes broad-spectrum agents with gram-negative and anaerobic coverage, with a duration of treatment based on the patient's general health status, immune status, severity of presentation, and CT findings 1. The underlying pathophysiology involves inflammation of diverticula, which can become infected when fecal matter gets trapped, leading to localized infection and inflammation that requires antibiotic therapy to resolve. Overall, the treatment of diverticulitis should prioritize a patient-centered approach, taking into account the individual's unique needs, values, and preferences, while also considering the latest evidence-based guidelines and recommendations 1.

From the Research

Treatment Options for Diverticulitis

• The treatment for diverticulitis typically involves a combination of medical and dietary interventions, with the goal of managing symptoms and preventing complications 2, 3, 4, 5.
• For patients with uncomplicated diverticulitis, outpatient treatment with oral antibiotics has been shown to be safe and effective, with success rates of over 92% 2 and 95% 4.
• The use of antibiotics such as metronidazole and ciprofloxacin has been commonly recommended for the treatment of diverticulitis, although recent studies suggest that observational therapy may be equally effective for patients with acute uncomplicated diverticulitis 6.

Medical Treatment

• Antibiotics are often prescribed to treat diverticulitis, with the goal of resolving the infection and inflammation 3, 4, 5.
• However, a recent meta-analysis found that there is no statistically significant difference in outcomes between patients with acute uncomplicated diverticulitis who were put on observational therapy compared to the antibiotics regime 6.
• Other medical treatments, such as mesalazine and probiotics, have also been studied as potential therapies for diverticulitis, with some evidence suggesting that they may be effective in improving symptoms and preventing recurrence 3.

Dietary Interventions

• A clear liquid diet is often recommended for patients with diverticulitis, with the goal of putting the intestine "at rest" and allowing it to recover 2, 4, 5.
• Patients may also be advised to avoid certain foods, such as nuts and seeds, which can exacerbate symptoms 3.

Outpatient vs. Inpatient Treatment

• Outpatient treatment has been shown to be safe and effective for patients with uncomplicated diverticulitis, with the advantage of reducing healthcare costs and resource utilization 2, 4, 5.
• However, patients with severe or complicated diverticulitis may require inpatient treatment, including intravenous antibiotics and surgical intervention 3, 4.