What is the treatment for diverticulitis?

From the Guidelines

Diverticulitis treatment should prioritize a selective approach to antibiotic use, reserving them for patients with complicated diverticulitis, those with comorbidities, or who present with severe symptoms, as recommended by the most recent guidelines from the American College of Physicians 1. The management of diverticulitis involves a comprehensive approach that includes:

• Pain management with over-the-counter pain relievers such as acetaminophen
• Dietary modifications, starting with a clear liquid diet for 2-3 days before gradually reintroducing solid foods
• Antibiotic therapy for select patients, with oral antibiotics like ciprofloxacin (500mg twice daily) plus metronidazole (500mg three times daily) for 7-10 days being a common regimen
• Consideration of hospitalization for intravenous antibiotics, bowel rest, and possibly surgical intervention if complications like perforation, abscess, or obstruction occur Key considerations in the management of diverticulitis include:
• The use of abdominal CT imaging to diagnose and stage diverticulitis, particularly in patients with diagnostic uncertainty or suspected complications
• The importance of identifying predictors of progression to complicated disease, such as symptoms lasting longer than 5 days, vomiting, systemic comorbidity, high C-reactive protein levels, and CT findings of pericolic extraluminal air or fluid collection
• The need for individualized decision-making, taking into account patient characteristics, presentation, and course of illness, as well as the potential benefits and harms of different management strategies Recent studies have shown that antibiotic treatment may not be necessary for all patients with uncomplicated diverticulitis, and that a selective approach to antibiotic use can help reduce the risk of antibiotic resistance and other adverse effects 1. In patients with uncomplicated diverticulitis, outpatient management is often sufficient, and hospitalization is typically reserved for those with complicated disease or severe symptoms 1. Overall, the goal of diverticulitis treatment is to manage symptoms, prevent complications, and improve quality of life, while also minimizing the risks and costs associated with different management strategies.

From the Research

Treatment Options for Diverticulitis

• The treatment of diverticulitis can be divided into uncomplicated and complicated cases, with different management strategies for each [(2,3,4,5,6)].
• For uncomplicated diverticulitis, outpatient treatment is recommended for afebrile, clinically stable patients, and antibiotics have no proven benefit in reducing the duration of the disease or preventing recurrence [(4,5)].
• In cases of uncomplicated diverticulitis, several studies have found similar outcomes in patients treated with or without antibiotics 5.
• Complicated diverticulitis, on the other hand, requires non-operative management, including bowel rest and intravenous antibiotics, for small abscesses, while larger abscesses may require percutaneous drainage [(4,6)].
• Surgical intervention is indicated for peritonitis, sepsis, or failure of non-operative management [(4,6)].

Medications Used in Treatment

• Antibiotics such as ampicillin, gentamicin, metronidazole, piperacillin, and tazobactam have been used to treat severe and complicated diverticulitis 2.
• Ciprofloxacin, metronidazole, and rifaximin have been used to treat uncomplicated diverticular disease 2.
• Mesalazine and probiotics have been studied as potential treatments for diverticulitis, with some evidence suggesting their effectiveness in preventing recurrence [(2,3)].

Management Strategies

• The management of diverticulitis has evolved towards more conservative and minimally invasive strategies, with a trend towards judicious use of antibiotics in uncomplicated cases 6.
• Laparoscopic management of non-faecal perforated diverticulitis is feasible in selected patients, and peritoneal lavage in combination with antibiotic therapy may avoid colonic resection and a stoma 6.
• Colonoscopy is recommended for all patients with complicated diverticulitis 6 weeks after CT diagnosis of inflammation, and for patients with uncomplicated diverticulitis who have suspicious features on CT scan or who otherwise meet national bowel cancer screening criteria 4.