From the Guidelines
For a patient with uncomplicated diverticulitis being discharged on Augmentin, the most recent and highest quality evidence suggests that antibiotics may not be necessary, and the patient can be safely discharged without them, as shown in the 2022 WSES guidelines 1. However, considering the patient is already being discharged on Augmentin, it is essential to ensure the treatment is appropriate and effective. The recommended regimen for Augmentin in uncomplicated diverticulitis is 875/125 mg orally twice daily for 7-10 days, as it provides adequate coverage against common enteric gram-negative and anaerobic bacteria involved in diverticulitis 1. Some key points to consider:
- Patients should take the medication with food to minimize gastrointestinal side effects.
- They should complete the entire course even if symptoms improve before completion.
- Common side effects include diarrhea, nausea, and rash.
- Patients should be advised to stay well-hydrated and initially follow a low-residue diet while acute symptoms resolve, then gradually return to a high-fiber diet to help prevent recurrence.
- They should seek immediate medical attention if symptoms worsen, fever develops, or they experience severe abdominal pain, as these could indicate treatment failure or complications requiring intravenous antibiotics or surgical intervention. It is crucial to note that the decision to use antibiotics should be based on the individual patient's risk factors, such as immunocompromised status, elderly age, or comorbidities, as suggested by the WSES guidelines 1. In general, the use of antibiotics in uncomplicated diverticulitis should be reserved for patients with systemic manifestations of infection or high-risk patients, as the majority of patients can be safely treated without them, according to the DIABOLO trial 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
ER Antibiotics for Uncomplicated Diverticulitis
- The use of antibiotics in uncomplicated diverticulitis is a topic of debate, with some studies suggesting that antibiotics may not be necessary for treatment 2.
- A study published in the Journal of the American College of Surgeons found that patients with uncomplicated diverticulitis can be safely discharged home on oral antibiotics, as long as CT findings are included in the decision-making process 3.
- Another study published in the Cochrane database of systematic reviews found that the effect of antibiotics on complications, emergency surgery, recurrence, elective colonic resections, and long-term complications is uncertain, and that the quality of the evidence is low 2.
- A survey of colon and rectal surgeons found that the majority of respondents chose amoxicillin/clavulanate (Augmentin) as an oral antibiotic for patients with uncomplicated diverticulitis 4.
- A study published in Colorectal Disease found that outpatient treatment with oral antibiotics (amoxicillin-clavulanic or ciprofloxacin plus metronidazole) is safe and effective for patients with uncomplicated acute diverticulitis 5.
Recommended Antibiotics
- Amoxicillin/clavulanate (Augmentin) is a commonly recommended antibiotic for uncomplicated diverticulitis 4, 5.
- Ciprofloxacin plus metronidazole is also a recommended antibiotic regimen for patients with uncomplicated diverticulitis 5.
- The choice of antibiotic should be based on the patient's medical history, allergy status, and other factors, as well as the severity of the disease 6, 4, 5.