What is the recommended dose of Augmentin (amoxicillin/clavulanate) for diverticulitis?

Augmentin Dosing for Diverticulitis

For uncomplicated diverticulitis requiring antibiotics, oral amoxicillin/clavulanic acid (Augmentin) should be administered at a dose of 875/125 mg twice daily for 5-7 days. 1

Patient Selection for Antibiotic Therapy

Not all patients with diverticulitis require antibiotics. According to current guidelines, antibiotics should be reserved for specific patient populations:

• Immunocompromised patients (transplant recipients, those on chemotherapy or high-dose steroids) 2, 1
• Patients with systemic symptoms (persistent fever, chills) 1
• Patients with increasing leukocytosis 1
• Elderly patients (>80 years) 1
• Pregnant patients 1
• Patients with chronic medical conditions (cirrhosis, chronic kidney disease, heart failure, poorly controlled diabetes) 1

For immunocompetent patients with uncomplicated diverticulitis without signs of systemic inflammation, observation with pain management and dietary modification is recommended without antibiotics 2.

Antibiotic Regimens

Oral Therapy (First-Line for Uncomplicated Cases)

• Amoxicillin/clavulanic acid (Augmentin): 875/125 mg twice daily for 5-7 days 1, 3
• Alternative for penicillin allergy: Ciprofloxacin 500 mg twice daily plus metronidazole 500 mg three times daily 1, 4

Intravenous Therapy (For Patients Unable to Tolerate Oral Intake)

• Amoxicillin/clavulanic acid: 1 g every 8 hours 3
• Alternative regimens:
  • Ceftriaxone plus metronidazole 1
  • Ampicillin/sulbactam 1
  • Piperacillin-tazobactam (for more severe cases) 2

Treatment Algorithm

1. Diagnosis confirmation: CT scan with IV contrast (sensitivity 98-99%, specificity 99%) 2
2. Assess severity: Uncomplicated vs. complicated diverticulitis
3. Determine need for antibiotics based on risk factors listed above
4. For uncomplicated diverticulitis requiring antibiotics:
   • Start with oral Augmentin if patient can tolerate oral intake
   • Use IV therapy if unable to tolerate oral medications, then transition to oral when improved
5. Duration: 5-7 days total if good clinical response 2
6. Monitoring: Reassess within 48-72 hours; expect pain resolution within 2-3 days 2

Special Considerations

• Transition from IV to oral therapy when the patient is clinically improving, afebrile for 24 hours, and able to tolerate oral intake 2
• Extended antibiotic therapy may be considered if there are ongoing signs of peritonitis or systemic illness beyond 5-7 days 2
• For complicated diverticulitis (abscess, perforation, fistula), more aggressive antibiotic therapy and possible surgical intervention are required 2, 1

Common Pitfalls to Avoid

1. Overuse of antibiotics in immunocompetent patients with uncomplicated diverticulitis without systemic symptoms 2
2. Inadequate duration of therapy for complicated cases
3. Failure to recognize treatment failure within 48-72 hours, which may indicate need for escalation of care 2
4. Missing complicated diverticulitis that requires surgical consultation or intervention
5. Not considering outpatient management for appropriate patients with uncomplicated diverticulitis 4

Remember that most patients with uncomplicated diverticulitis improve within 24-48 hours of appropriate management 3. Consider colonoscopy 4-6 weeks after resolution of complicated diverticulitis to rule out malignancy 2.