From the Guidelines
Diverticulitis should be treated with antibiotics selectively, rather than routinely, in immunocompetent patients with mild acute uncomplicated diverticulitis, as recent evidence suggests there is no benefit in this patient population 1.
Diagnosis and Treatment
The diagnosis of diverticulitis is often made using computed tomography (CT) scans, and treatment depends on the severity of the disease.
- Mild cases can be managed at home with oral antibiotics, such as amoxicillin-clavulanate 875/125 mg twice daily or ciprofloxacin 500 mg twice daily plus metronidazole 500 mg three times daily for 7-10 days, and a clear liquid diet for 2-3 days, followed by a gradual return to normal eating as symptoms improve 1.
- Pain can be managed with acetaminophen or, if needed, prescription pain medication.
- Severe cases require hospitalization for IV antibiotics, bowel rest, and possibly surgery.
Prevention of Recurrence
To prevent recurrence, patients should:
- Maintain a high-fiber diet (25-30 grams daily) 1
- Stay well-hydrated
- Exercise regularly
- Avoid constipation
- Avoid smoking and certain medications like NSAIDs
Risk Factors
Diverticulitis occurs when bacteria get trapped in diverticula, causing inflammation and infection. Risk factors include:
- Age over 40
- Low-fiber diet
- Obesity
- Smoking
- Certain medications like NSAIDs If you experience severe abdominal pain, fever, inability to keep fluids down, or worsening symptoms, seek immediate medical attention as complications can be serious 1.
From the Research
Diagnosis of Diverticulitis
- Radiological evidence of inflammation, using computed tomography (CT), is needed to diagnose the first occurrence of diverticulitis 2
- CT is also warranted when the severity of symptoms suggests that perforation or abscesses have occurred 2
- Diverticulitis is classified as complicated or uncomplicated based on CT scan, severity of symptoms and patient history; this classification is used to direct management 2
Treatment of Uncomplicated Diverticulitis
- Outpatient treatment is recommended in afebrile, clinically stable patients with uncomplicated diverticulitis 2
- Antibiotics have no proven benefit in reducing the duration of the disease or preventing recurrence, and should only be used selectively 2
- Treatment of acute uncomplicated diverticulitis without antibiotics is feasible, safe, and effective 3
- Adding broad-spectrum antibiotics to the treatment regimen did not serve to decrease treatment failure, recurrence, complications, hospital readmissions, and need for surgery significantly compared to non-antibiotic treatment 3
Treatment of Complicated Diverticulitis
- Non-operative management, including bowel rest and intravenous antibiotics, is indicated for small abscesses 2
- Larger abscesses of 3-5 cm should be drained percutaneously 2
- Patients with peritonitis and sepsis should receive fluid resuscitation, rapid antibiotic administration and urgent surgery 2
- Surgical intervention with either Hartmann procedure or primary anastomosis, with or without diverting loop ileostomy, is indicated for peritonitis or in failure of non-operative management 2
Antibiotic Therapy
- For patients with severe and complicated diverticulitis, ampicillin, gentamicin, metronidazole, piperacillin and tazobactam are the antibiotics successfully used in clinical practice 4
- Ciprofloxacin, metronidazole and more recently, rifaximin, have been successfully used in the treatment of uncomplicated diverticular disease 4
- Mesalazine (alone or in association with antibiotics) and probiotics are the two latest therapies for the treatment of diverticulitis which have been developed in the last few years 4