What is the diagnosis for a 63-year-old male (sixty-three male) with a flare of suspected diverticulitis (inflammation of the diverticula)

From the Guidelines

I would not recommend prescribing antibiotics over the phone without proper evaluation for suspected diverticulitis. The patient should be seen in person for assessment, as diverticulitis requires confirmation through physical examination and possibly imaging studies, such as abdominal CT imaging, which is suggested by the American College of Physicians 1 and the Infectious Diseases Society of America 1. While antibiotics like amoxicillin-clavulanate (875/125 mg twice daily for 7-10 days) or ciprofloxacin (500 mg twice daily) plus metronidazole (500 mg three times daily) for 7-10 days are common treatments for uncomplicated diverticulitis, prescribing without proper diagnosis could lead to inappropriate treatment.

• The patient's symptoms, such as abdominal pain, fever, or inability to tolerate fluids, should be evaluated in person to determine the best course of action.
• The American College of Physicians suggests that clinicians use abdominal CT imaging when there is diagnostic uncertainty in a patient with suspected acute left-sided colonic diverticulitis 1.
• The Infectious Diseases Society of America recommends computed tomography as the initial imaging modality for non-pregnant adults with suspected diverticulitis due to its high diagnostic accuracy for diverticulitis 1. The patient should be advised to go to urgent care or the emergency department for evaluation. Complications of untreated diverticulitis can include abscess formation, perforation, or peritonitis. While waiting for medical attention, the patient can use acetaminophen for pain relief and maintain a clear liquid diet. Self-diagnosis of diverticulitis is unreliable, even in patients with previous episodes, as symptoms can mimic other serious abdominal conditions requiring different management approaches.

From the Research

Diagnosis and Treatment of Diverticulitis

• The diagnosis of diverticulitis is typically made using abdominal computed tomography (CT) scans, which can help identify inflammation and determine the severity of the condition 2.
• Uncomplicated diverticulitis can be treated on an outpatient basis with oral antibiotics, such as amoxicillin-clavulanic acid or ciprofloxacin plus metronidazole, for 7-10 days 3, 4, 5.
• The choice of antibiotic regimen may depend on the patient's medical history, allergy status, and other factors, with some studies suggesting that amoxicillin-clavulanate may be a suitable alternative to fluoroquinolone-based regimens 6.

Outpatient Treatment and Management

• Outpatient treatment is recommended for afebrile, clinically stable patients with uncomplicated diverticulitis, and may involve a clear liquid diet for the first 2 days, followed by a gradual return to normal diet 3, 5.
• Patients with uncomplicated diverticulitis may not require antibiotics, as they have not been shown to reduce the duration of the disease or prevent recurrence 2.
• Regular follow-up appointments are necessary to monitor the patient's condition and adjust treatment as needed.

Considerations for Antibiotic Use

• The use of antibiotics in diverticulitis treatment should be selective, taking into account the patient's individual needs and medical history 2.
• Fluoroquinolone-based regimens may be associated with a higher risk of Clostridioides difficile infection (CDI) compared to amoxicillin-clavulanate 6.
• The choice of antibiotic regimen should be guided by evidence-based guidelines and clinical judgment, taking into account the potential benefits and harms of different treatment options 6.