From the Guidelines
For diffuse diverticulosis, the most effective medications are fiber supplements such as psyllium (Metamucil) or methylcellulose (Citrucel) at a dose of 3-6 grams daily, which can help regulate bowel movements and reduce pressure in the colon. The condition itself doesn't require treatment, but rather management to prevent complications. If symptoms like pain or bloating are present, starting with a low dose of fiber supplements and gradually increasing can help avoid gas and bloating. For occasional constipation, stool softeners like docusate sodium (100-300 mg daily) may help.
According to the American College of Physicians guideline 1, mesalamine is not recommended to prevent recurrent diverticulitis due to high-certainty evidence showing no difference in risk for recurrent diverticulitis compared with placebo. The guideline also suggests that clinicians discuss elective surgery to prevent recurrent diverticulitis after initial treatment in patients who have either uncomplicated diverticulitis that is persistent or recurs frequently or complicated diverticulitis.
For patients with diverticulitis, antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily) or a combination of ciprofloxacin (500 mg twice daily) and metronidazole (500 mg three times daily) for 7-10 days may be prescribed, as recommended by the AGA clinical practice update on medical management of colonic diverticulitis 1. A high-fiber diet (25-30 grams daily) and adequate hydration (at least 8 glasses of water daily) are also essential in managing diverticulosis.
Some key points to consider:
- Fiber supplements can help regulate bowel movements and reduce pressure in the colon
- Stool softeners like docusate sodium may help with occasional constipation
- Antibiotics may be prescribed for diverticulitis, but should be used selectively
- A high-fiber diet and adequate hydration are crucial in managing diverticulosis
- Elective surgery may be discussed for patients with persistent or frequently recurring diverticulitis.
From the Research
Effective Medications for Diffuse Diverticulosis
- Fibre supplementation is recommended for asymptomatic diverticulosis to reduce intraluminal pressure and slow down the worsening of the disease 2
- For symptomatic diverticulosis, a combination of soluble fibre, such as glucomannan, and poorly absorbed antibiotics, like rifaximin, can provide symptom relief and prevent acute diverticulitis 2
- Mesalazine, rifaximin, and probiotics are also considered effective therapies for symptomatic diverticular disease 3, 4
- Rifaximin plus fibre supplementation has been shown to be effective in obtaining symptom relief and preventing complications at 1 year in patients with symptomatic uncomplicated diverticular disease 5
- Non-absorbable antibiotics, 5-aminosalicylic acid, and probiotics are currently being investigated for the treatment of diverticulosis 6
Treatment Approaches
- Outpatient management with oral antibiotics is considered the optimal approach for uncomplicated diverticulitis 3
- Hospitalization and intravenous antibiotics are recommended for complicated diverticulitis or when the patient is unable to intake food orally, has severe comorbidity, or does not improve 3, 2
- Surgery may be necessary in cases of diffuse peritonitis, abscesses, fistulas, stenosis, or after multiple attacks of uncomplicated diverticulitis 2