What is the treatment for diverticulitis (inflammation of the diverticula)?

From the Guidelines

Diverticulitis treatment should be tailored to the individual patient's condition, with antibiotics recommended for patients with complicated diverticulitis, those with comorbidities or who are frail, and those with refractory symptoms or vomiting, as well as a CRP >140 mg/L or baseline white blood cell count > 15 × 10^9 cells per liter, as stated in the 2021 AGA clinical practice update 1. The treatment approach for diverticulitis has evolved, with recent evidence suggesting that antibiotics may not be necessary for all patients with acute uncomplicated diverticulitis, particularly those who are immunocompetent and without signs of systemic inflammation, as recommended by the 2020 WSES guidelines 1.

Key Considerations

• Patients with uncomplicated diverticulitis who are immunocompetent and without signs of systemic inflammation may not require antibiotic therapy, as supported by high-quality evidence 1.
• Antibiotic treatment is advised for patients with complicated diverticulitis, those with comorbidities or who are frail, and those with refractory symptoms or vomiting, as well as a CRP >140 mg/L or baseline white blood cell count > 15 × 10^9 cells per liter, as stated in the 2021 AGA clinical practice update 1.
• The choice of antibiotic regimen should include broad-spectrum agents with gram-negative and anaerobic coverage, such as a combination of an oral fluoroquinolone and metronidazole or monotherapy with oral amoxicillin-clavulanate, with treatment duration typically ranging from 4-7 days 1.

Treatment Approach

• For mild cases of diverticulitis, home treatment with rest, liquid diet, and oral antibiotics (if necessary) may be effective, with gradual reintroduction of low-fiber foods and transition to a high-fiber diet once symptoms resolve.
• Severe cases require hospitalization for intravenous antibiotics, bowel rest, and possibly surgery if complications like perforation, abscess, or obstruction occur.
• Preventing recurrence involves maintaining a high-fiber diet, drinking plenty of water, exercising regularly, and avoiding NSAIDs when possible.

From the Research

Treatment for Diverticulitis

The treatment for diverticulitis, which is the inflammation of the diverticula, can vary depending on the severity of the condition.

• For uncomplicated diverticulitis, the standard therapy is a liquid diet and oral antimicrobials, usually ciprofloxacin and metronidazole 2.
• Hospitalization, bowel rest, and intravenous antibacterial agents are mandatory for complicated diverticulitis 2.
• Outpatient treatment with oral antibiotics has been shown to be safe and effective for uncomplicated acute diverticulitis, with a success rate of over 92% 3, 4.
• The treatment typically consists of oral antibiotics for 10 days, a liquid diet, and oral analgesics 4.
• For mild diverticulitis, treatment should essentially be focused on hydration and adjustments in the dietary regimen, with antibiotics not necessary when the course is uncomplicated and improvement is achieved 5.
• However, antibiotics are reserved for the treatment of severe or repeated diverticulitis, sepsis, and complications 5.

Prevention of Further Attacks

To prevent further attacks of diverticulitis, the following measures can be taken:

• Continuous fiber intake 2
• Intermittent course of rifaximin 2, 5
• Probiotics 6, 5
• Mesalazine 6, 5
• Non-absorbable antibiotics, such as rifaximin, given cyclically 5

Surgical Treatment

Surgical treatment is typically reserved for complicated cases of diverticulitis, such as:

• Diffuse peritonitis
• Abscesses
• Fistulas
• Stenosis
• After the second to fourth attack of uncomplicated diverticulitis 2
• Young people and immunocompromised patients are more likely to require surgical treatment 2