From the Guidelines
Diverticulitis treatment should be individualized, with antibiotics used selectively, rather than routinely, in patients with acute uncomplicated diverticulitis, and reserved for those with complicated diverticulitis, systemic inflammatory response, or high-risk patients, such as the immunocompromised or elderly, as recommended by the American College of Physicians (1). The treatment approach for diverticulitis depends on the severity of the condition and the presence of complications. For mild cases, outpatient management with oral antibiotics, such as ciprofloxacin and metronidazole, for 7-10 days, along with a clear liquid diet and over-the-counter pain relievers, like acetaminophen, may be sufficient (1). Some key points to consider in the management of diverticulitis include:
- The use of abdominal CT imaging for diagnosis, especially when there is diagnostic uncertainty, due to its high sensitivity and specificity (1).
- Outpatient management for most patients with acute uncomplicated diverticulitis, as it may reduce the risk of hospital-acquired infections and is more cost-effective (1).
- The selective use of antibiotics, with consideration of the patient's immune status, presence of systemic inflammatory response, and risk factors for complications (1).
- Dietary modifications, including a high-fiber diet (25-30g daily) with adequate hydration, to reduce pressure in the colon and prevent recurrence (1).
- Regular physical activity to support bowel health (1). It is essential to note that more severe cases, or those with complications, may require hospitalization for intravenous antibiotics, bowel rest, and possibly surgical intervention (1). The American College of Physicians recommends a conditional approach to the management of acute left-sided colonic diverticulitis, taking into account the individual patient's circumstances, such as the availability of adequate home care, and the potential benefits and harms of different management strategies (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 and lifestyle changes. The primary goal of treatment is to resolve the infection, reduce inflammation, and prevent complications.
- 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, antibiotics like 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, with mesalazine and antibiotic combinations demonstrating superiority in improving symptoms and preventing recurrence 2.
- Outpatient treatment with oral antibiotics, such as metronidazole and ciprofloxacin, has been proven safe and effective for patients with uncomplicated acute diverticulitis, with success rates over 92% 3, 4.
- The use of antibiotics in uncomplicated diverticulitis is questionable, with some studies suggesting that the condition may be inflammatory rather than infectious, and the evidence on antibiotic treatment is uncertain 5.
Approach to Treatment
The approach to treating diverticulitis can vary depending on the severity of the condition and the patient's overall health.
- For mild cases, outpatient treatment with oral antibiotics and a liquid diet may be sufficient 3, 4.
- In more severe cases, hospital admission and intravenous antibiotics may be necessary 6.
- In some instances, minimally invasive procedures such as percutaneous drainage of diverticular abscesses or laparoscopic management of non-faecal perforated diverticulitis may be feasible 6.
- The trend in treating diverticulitis is towards a more conservative and minimally invasive management approach, with judicious use of antibiotics and greater application of laparoscopic techniques 6.