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

From the Guidelines

For patients with uncomplicated diverticulitis, antibiotics can be safely omitted, and treatment should focus on pain management and dietary modifications. This approach is supported by the most recent and highest quality study, which found that observational treatment without antibiotics did not prolong recovery and could be considered appropriate in these patients 1. The study included 528 patients with Hinchey modified stages 1a and 1b diverticulitis and found no significant differences in outcomes between the observation and antibiotic treatment groups.

Key Considerations

• The decision to use antibiotics should be based on the severity of the disease and the presence of systemic manifestations of infection or high-risk patients, such as immunocompromised patients, elderly patients, and those with comorbidities 1.
• Oral administration of antibiotics may be equally as effective as intravenous administration, and an expeditious switch from intravenous to oral may allow for rapid patient discharge 1.
• A high-fiber diet (25-30g daily) with adequate hydration can help prevent recurrence by reducing pressure in the colon, and fiber should be increased gradually to avoid bloating and gas 1.
• Regular physical activity also supports bowel health and can help prevent recurrence 1.

Treatment Approach

• For mild cases, oral antibiotics like ciprofloxacin (500mg twice daily) plus metronidazole (500mg three times daily) for 7-10 days may be recommended, along with a clear liquid diet for 2-3 days before gradually reintroducing solid foods 1.
• Over-the-counter pain relievers such as acetaminophen can help manage discomfort.
• More severe cases may require hospitalization for intravenous antibiotics, bowel rest, and possibly surgical intervention if complications like perforation, abscess, or obstruction occur.

Elective Resection

• The decision to perform an elective resection after one or more episodes of acute diverticulitis should be undertaken on a case-by-case basis, taking into account risk factors, complications, age, and severity of episodes as well as the patient’s personal circumstances and comorbidities 1.
• Elective sigmoid resection may be considered in high-risk patients, such as immunocompromised patients, but the indication for elective colectomy following 2 episodes of diverticulitis is no longer accepted 1.

From the Research

Treatment Options for Diverticulitis

The treatment for diverticulitis, which is the inflammation of the diverticula, typically involves a combination of medical therapies aimed at resolving the infection, reducing inflammation, and preventing complications. The specific treatment approach may vary depending on the severity of the condition.

Medical Therapies

• For patients with severe and complicated diverticulitis, antibiotics such as ampicillin, gentamicin, metronidazole, piperacillin, and tazobactam are commonly used 2.
• In cases of uncomplicated diverticular disease, ciprofloxacin, metronidazole, and rifaximin have been successfully used 2.
• Mesalazine, either alone or in combination with antibiotics, and probiotics are newer therapies that have shown promise in treating diverticulitis 2.
• The combination of mesalazine and an antibiotic has been shown to be more effective than antibiotics alone in improving symptoms and preventing recurrence 2.

Outpatient Treatment

• Outpatient treatment with oral antibiotics, such as metronidazole and ciprofloxacin, has been demonstrated to be safe and effective for patients with uncomplicated acute diverticulitis 3.
• A study found that outpatient treatment was successful in over 92% of cases, with only 8% of patients requiring admission 3.
• Another study found that outpatient treatment for uncomplicated and mild complicated diverticulitis had a lower failure rate compared to inpatient treatment 4.

Conservative Treatment

• Conservative treatment strategies, such as liquid diet and oral analgesics, can be effective for patients with mild diverticulitis 3, 5.
• Some patients with uncomplicated diverticulitis can be treated without antibiotics, bed rest, or dietary restrictions 5.
• A study found that antibiotics can be omitted in selected patients with mild colonic diverticulitis, and should be given on indication only 6.