What is the recommended Augmentin (amoxicillin/clavulanate) regimen for treating diverticulitis?

Augmentin Regimen for Diverticulitis

For outpatient treatment of uncomplicated diverticulitis when antibiotics are indicated, amoxicillin-clavulanate (Augmentin) is recommended as a first-line oral antibiotic option for 4-7 days in immunocompetent patients. 1, 2, 3

When to Use Antibiotics (and Therefore Augmentin)

Antibiotics are not routinely recommended for all cases of uncomplicated diverticulitis in immunocompetent patients. 1, 2 Reserve antibiotic therapy for patients with:

• Immunocompromised status (chemotherapy, high-dose steroids, organ transplant recipients) 1, 3
• Age >80 years 1, 3
• Pregnancy 1, 3
• Systemic symptoms: persistent fever, chills, or signs of sepsis 1, 3
• Increasing leukocytosis (WBC >15 × 10^9 cells/L) 1
• Elevated inflammatory markers (CRP >140 mg/L) 1
• CT findings: fluid collection or longer segment of inflammation 1
• Chronic medical conditions: cirrhosis, chronic kidney disease, heart failure, poorly controlled diabetes 3
• Clinical factors: symptoms >5 days, vomiting, ASA score III or IV, refractory symptoms 1

Specific Augmentin Dosing

While the guidelines cite amoxicillin-clavulanate as an appropriate option 1, 2, 3, the standard adult dosing is 875 mg/125 mg orally twice daily or 500 mg/125 mg three times daily for 4-7 days. 4

Alternative oral regimen if penicillin allergy: ciprofloxacin 500 mg twice daily plus metronidazole 500 mg three times daily for 4-7 days. 1, 2, 4

Duration of Therapy

• Immunocompetent patients: 4-7 days 1, 2
• Immunocompromised patients: 10-14 days 1

Outpatient vs. Inpatient Decision

Outpatient management with oral Augmentin is appropriate when patients: 1, 4

• Can tolerate oral intake
• Have no significant comorbidities or frailty
• Have adequate home support
• Show no signs of systemic inflammatory response or sepsis

Inpatient management with IV antibiotics is required for: 1, 5, 3

• Inability to tolerate oral intake
• Severe pain or systemic symptoms
• Complicated diverticulitis (abscess, perforation, obstruction)
• Significant comorbidities or frailty
• Failed outpatient management

Important Clinical Caveats

• Re-evaluate within 7 days of starting treatment; earlier if clinical condition deteriorates 1
• Transition to oral antibiotics (including Augmentin) as soon as possible in hospitalized patients to facilitate earlier discharge 1
• Avoid alcohol until at least 48 hours after completing metronidazole if that alternative regimen is used 1
• Do not stop antibiotics early even if symptoms improve, as this may lead to incomplete treatment and recurrence 1
• Monitor for warning signs requiring immediate attention: fever >101°F, severe uncontrolled pain, persistent vomiting, inability to eat/drink, signs of dehydration 1

Coverage Rationale

Augmentin provides appropriate coverage for the polymicrobial nature of diverticulitis, targeting Gram-positive, Gram-negative, and anaerobic bacteria commonly involved in colonic infections. 6 The amoxicillin component covers most Gram-positive and many Gram-negative organisms, while clavulanate extends coverage to beta-lactamase-producing bacteria, and the combination provides adequate anaerobic coverage. 3, 4