Is it safe to take prednisone (corticosteroid) with acute diverticulitis?

Prednisone Use in Acute Diverticulitis

Prednisone (corticosteroid) therapy is not recommended for patients with acute diverticulitis as it significantly increases the risk of treatment failure and may lead to higher rates of emergency surgery and mortality. 1

Risk of Corticosteroids in Diverticulitis

Immunocompromised patients, particularly those on chronic corticosteroid therapy like prednisone, are at substantially higher risk for complications with acute diverticulitis:

• The World Society of Emergency Surgery (WSES) guidelines specifically identify patients on chronic corticosteroid therapy as being at high risk for failure of standard non-operative treatment (weak recommendation based on very low-quality evidence) 1
• A study by Biondo et al. found that patients on chronic corticosteroid therapy required emergency surgery more frequently than other immunocompromised groups 1
• The postoperative mortality rate in immunocompromised patients with diverticulitis was reported to be 31.6% 1
• Recurrence rates after initially successful non-operative management were 27.8% in immunocompromised patients 1

Medication Considerations in Diverticulitis Management

Medications to Avoid

• Corticosteroids (including prednisone): Associated with higher risk of treatment failure and complications 1, 2
• NSAIDs: The American Gastroenterological Association (AGA) suggests advising patients with a history of diverticulitis to avoid non-aspirin NSAIDs if possible 1
• Opiates: May increase risk of diverticular complications 2, 3

Medications That May Be Used

• Aspirin: The AGA suggests against routinely advising patients with a history of acute diverticulitis to avoid aspirin 1
• Acetaminophen: Preferred for pain management in uncomplicated diverticulitis 3

Treatment Approach for Acute Diverticulitis

For patients with acute diverticulitis who require medication:

1. First-line pain management: Acetaminophen rather than NSAIDs or opioids 3

2. Antibiotic therapy:

   • For uncomplicated diverticulitis in immunocompetent patients without systemic inflammation, antibiotics are not routinely recommended 1, 2
   • For immunocompromised patients (including those on corticosteroids), broad-spectrum antibiotics are recommended 2, 3
   • Oral regimens when possible: amoxicillin-clavulanate or cefalexin with metronidazole 2, 3
   • IV regimens when needed: ceftriaxone plus metronidazole or piperacillin-tazobactam 2, 3

Special Considerations for Patients Already on Prednisone

If a patient is already on prednisone for another condition and develops acute diverticulitis:

• Consider the patient high-risk for complicated diverticulitis 1
• Lower threshold for hospitalization and IV antibiotics 2
• Close monitoring for clinical deterioration is mandatory 2
• Early surgical consultation may be warranted 1
• CT imaging is essential for accurate diagnosis and assessment of disease severity 2

Prevention Strategies

For patients with a history of diverticulitis:

• High-fiber diet and fiber supplementation 1, 2
• Regular physical activity 2
• Avoid NSAIDs when possible 1, 2
• Avoid corticosteroids when possible 2, 3

Key Takeaway

The evidence strongly suggests avoiding prednisone in patients with acute diverticulitis whenever possible. If a patient requires corticosteroids for another condition, they should be considered at high risk for complications and managed accordingly with close monitoring and early intervention if clinical deterioration occurs.