From the Guidelines
Diverticulitis treatment should prioritize a selective use of antibiotics, reserving them for patients with complicated diverticulitis, immunocompromised individuals, or those with systemic manifestations of infection, as evidenced by recent guidelines and studies 1.
Key Considerations
- The management of diverticulitis depends on its severity, with mild cases often managed conservatively and severe cases requiring hospitalization and possibly surgery.
- Antibiotic treatment can be used selectively in immunocompetent patients with mild acute uncomplicated diverticulitis, as recent evidence suggests no benefit in this group 1.
- Patients with complicated diverticulitis or those who are immunocompromised should receive antibiotic treatment, as it is strongly advised in these cases 1.
- A high-quality diet, normal body mass index, regular physical activity, avoidance of smoking, and limited use of nonsteroidal anti-inflammatory drugs (except for aspirin prescribed for secondary prevention of cardiovascular disease) can help reduce the risk of recurrence 1.
Treatment Approach
- For mild cases, treatment may include oral antibiotics (such as amoxicillin-clavulanate or ciprofloxacin plus metronidazole), a clear liquid diet for 2-3 days, and gradual return to normal eating as symptoms improve.
- Pain management can be achieved with acetaminophen or prescription pain medication if necessary.
- Severe cases require hospitalization for IV antibiotics, bowel rest, and possibly surgery.
Prevention of Recurrence
- Maintaining a high-fiber diet (25-30 grams daily) is crucial.
- Staying well-hydrated and exercising regularly can also help prevent recurrence.
- Avoiding constipation and limiting the use of certain medications like NSAIDs can further reduce the risk of diverticulitis recurrence.
Important Considerations
- Diverticulitis can lead to serious complications if not properly managed, including abscesses, perforations, and peritonitis.
- Seeking immediate medical attention is essential if symptoms worsen or if there are signs of complications such as severe abdominal pain, fever, inability to keep fluids down, or vomiting.
From the Research
Diagnosis and Classification of Diverticulitis
- Diverticulitis is diagnosed using radiological evidence of inflammation, typically through computed tomography (CT) scans 2.
- The classification of diverticulitis as complicated or uncomplicated is based on CT scan results, severity of symptoms, and patient history, which guides management decisions 2.
Treatment of Uncomplicated Diverticulitis
- Outpatient treatment is recommended for afebrile, clinically stable patients with uncomplicated diverticulitis 2.
- Antibiotics have no proven benefit in reducing the duration of the disease or preventing recurrence in uncomplicated diverticulitis and should be used selectively 2.
- Ambulatory treatment protocols, including oral antibiotics and a clear liquid diet, have been shown to be safe and effective for most patients with uncomplicated acute diverticulitis 3, 4.
Treatment of Complicated Diverticulitis
- Non-operative management, including bowel rest and intravenous antibiotics, is indicated for small abscesses, while larger abscesses may require percutaneous drainage 2.
- Patients with peritonitis and sepsis require fluid resuscitation, rapid antibiotic administration, and urgent surgery 2.
- Surgical intervention, such as Hartmann procedure or primary anastomosis, may be necessary for peritonitis or failure of non-operative management 2.
Follow-up and Prevention
- Colonoscopy is recommended for all patients with complicated diverticulitis 6 weeks after CT diagnosis of inflammation, as well as for patients with uncomplicated diverticulitis who have suspicious features on CT scan or meet national bowel cancer screening criteria 2.
- There is limited evidence on the optimal duration of antimicrobial therapy for diverticulitis, and careful clinical studies are needed to evaluate antibiotic regimens for the treatment of this disease 5.