Can Scheriproct (prednisolone) be given to patients with diverticulitis?

Scheriproct (Prednisolone) Should Not Be Used in Patients with Diverticulitis

Scheriproct (containing prednisolone) should be avoided in patients with diverticulitis as corticosteroids are associated with increased risk of diverticulitis and perforation. 1

Rationale for Avoiding Corticosteroids in Diverticulitis

Mechanism of Risk

• Corticosteroids like prednisolone in Scheriproct can:
  • Suppress immune response needed to fight infection in diverticulitis
  • Mask symptoms of worsening infection
  • Increase risk of perforation
  • Impair tissue healing processes

Evidence Base

The American Gastroenterological Association (AGA) clinical practice guidelines specifically note that "opiate analgesics, like corticosteroids, are associated with diverticulitis and perforation" 1. This indicates that corticosteroids not only may worsen existing diverticulitis but are actually a risk factor for developing the condition.

Management Approach for Diverticulitis

Uncomplicated Diverticulitis

• Class A or B patients (stable, minimal comorbidities):

  • Conservative treatment without antibiotics 1
  • High-fiber diet after resolution 2
  • Avoid NSAIDs and corticosteroids 1

• Class C patients (significant comorbidities):

  • Short course antibiotic therapy (5-7 days) 1
  • If sepsis present: more aggressive antibiotic therapy 1

Complicated Diverticulitis

• Small abscesses (<4-5 cm):

  • Antibiotic therapy alone 1, 2

• Large abscesses (≥4-5 cm):

  • Percutaneous drainage plus antibiotics 1, 2
  • If drainage not feasible: antibiotic therapy or surgical intervention 1

• Peritonitis:

  • Surgical intervention with antibiotic therapy 1
  • In hemodynamically unstable patients: damage control surgery may be considered 1

Medication Considerations in Diverticulitis

Medications to Avoid

• Corticosteroids (including Scheriproct/prednisolone) 1
• Non-aspirin NSAIDs 1
• Opiates 1

Medications Not Recommended for Prevention

• 5-aminosalicylic acid (mesalamine) 1
• Probiotics 1
• Rifaximin 1

Key Clinical Pitfalls

1. Using corticosteroids in diverticulitis: May mask symptoms and increase risk of perforation
2. Failure to recognize deterioration: Patients on corticosteroids may not show typical inflammatory markers
3. Inappropriate use of NSAIDs: Can increase risk of complications
4. Overuse of antibiotics: Not always necessary in mild uncomplicated cases
5. Delayed drainage of large abscesses: Should be performed promptly when indicated

Follow-up Recommendations

• Monitor for treatment failure with persistent symptoms
• Consider colonoscopy 4-6 weeks after resolution of complicated diverticulitis to rule out malignancy 2
• Advise high-fiber diet and regular physical activity for prevention of recurrence 2
• Counsel patients to avoid corticosteroids and NSAIDs long-term 1

In conclusion, the use of Scheriproct or any prednisolone-containing product is contraindicated in patients with diverticulitis due to the increased risk of complications and potential to mask worsening infection.