Treatment of Recurrent Diverticulitis with Antibiotics
Yes, taking Augmentin (amoxicillin-clavulanate) and Flagyl (metronidazole) together is an appropriate antibiotic regimen for recurrent diverticulitis, though monotherapy with Augmentin alone is equally effective and may be preferable to avoid unnecessary antibiotic exposure. 1
Antibiotic Selection for Diverticulitis
First-Line Options:
- Amoxicillin-clavulanate (Augmentin) monotherapy - Recommended as an effective first-line treatment 1, 2
- Metronidazole plus fluoroquinolone combination - Alternative regimen but with increased risk of C. difficile infection in older patients 2
Research comparing these regimens found no significant differences in:
- Hospital admission rates
- Need for urgent surgery
- Need for elective surgery
- Treatment failure rates 2
However, the metronidazole-fluoroquinolone combination showed a higher risk of C. difficile infection in Medicare patients (0.6 percentage points higher) 2.
Dosing and Duration:
- Standard duration: 4-7 days for uncomplicated cases 1
- Extended duration: 10-14 days for immunocompromised patients 1
- Dosing: For more severe infections, one 875-mg tablet of Augmentin every 12 hours or one 500-mg tablet every 8 hours 3
- Take Augmentin at the start of a meal to minimize gastrointestinal intolerance 3
Treatment Algorithm Based on Patient Factors
For Uncomplicated Recurrent Diverticulitis:
- First choice: Amoxicillin-clavulanate monotherapy for 4-7 days 1, 2
- Alternative: Metronidazole plus fluoroquinolone if unable to tolerate Augmentin 1
For Higher Risk Patients (consider longer treatment):
- Immunocompromised status
- ASA score III or IV
- Symptoms >5 days before presentation
- Presence of vomiting
- CRP >140 mg/L
- WBC >15 × 10^9 cells/L
- Fluid collection or longer segment of inflammation on CT 1
Outpatient vs. Inpatient Management
Most patients with uncomplicated diverticulitis can be safely managed as outpatients 1, 4. Consider outpatient treatment if:
- No significant comorbidities
- Able to take fluids orally
- Can manage self-care at home 1
Re-evaluation should occur within 7 days, or earlier if symptoms worsen 1.
Prevention of Recurrence
To reduce risk of recurrence:
- Consume a high-fiber diet (fruits, vegetables, whole grains, legumes)
- Achieve/maintain normal BMI
- Regular physical activity
- Smoking cessation 1
- Avoid NSAIDs when possible 1
Important Cautions
- Combination therapy caution: While both Augmentin and Flagyl can be used together, monotherapy with Augmentin alone is equally effective and reduces unnecessary antibiotic exposure 2
- Monitoring: Watch for side effects of Augmentin including diarrhea (9%), nausea (3%), skin rashes (3%), and rarely hepatic dysfunction 3
- Follow-up: If symptoms do not improve within 48-72 hours, seek medical attention for reassessment 5
Remember that approximately 50% of diverticulitis risk is attributable to genetic factors, so even with optimal management, recurrences may still occur 1.