From the Guidelines
The recommended duration of oral antibiotics for outpatient treatment of diverticulitis is 4-7 days.
Key Considerations
- The decision to use antibiotics should be based on individual patient factors, such as the presence of comorbidities, refractory symptoms, or elevated inflammatory markers 1.
- Patients with uncomplicated diverticulitis who are immunocompetent and have mild symptoms may not require antibiotics 1.
- The choice of antibiotic regimen should provide broad-spectrum coverage, including gram-negative and anaerobic organisms 1.
- Common oral antibiotic regimens for outpatient treatment of diverticulitis include a combination of a fluoroquinolone and metronidazole or monotherapy with amoxicillin-clavulanate 1.
Evidence Summary
- A systematic review and meta-analysis of 9 studies found no difference in outcomes between patients with acute uncomplicated diverticulitis who received antibiotics and those who did not 1.
- The American Gastroenterological Association (AGA) suggests that antibiotics should be used selectively, rather than routinely, in patients with acute uncomplicated diverticulitis 1.
- The American College of Physicians (ACP) recommends that clinicians initially manage select patients with acute uncomplicated left-sided colonic diverticulitis without antibiotics 1.
- The duration of antibiotic treatment is usually 4-7 days, but may be longer based on individual patient factors, such as severity of presentation and CT findings 1.
From the Research
Recommended Duration of Oral Antibiotics
The recommended duration of oral antibiotics for outpatient treatment of diverticulitis is not consistently defined in the provided studies. However, some studies provide insight into the treatment duration:
- A study published in 2016 2 used oral antibiotics for 10 days (metronidazole 500 mg/8 h and ciprofloxacin 500 mg/12 h) for outpatient treatment of uncomplicated acute diverticulitis.
- Another study published in 2014 3 does not specify the exact duration of oral antibiotics, but mentions that the first dose of antibiotic was given intravenously to all patients in the emergency department and then patients were either hospitalized or discharged.
Key Findings
Some key findings from the studies include:
- Outpatient treatment of uncomplicated acute diverticulitis is feasible and safe 4, 2, 3.
- The use of antibiotics for acute uncomplicated diverticulitis is not consistently supported by the literature, with some studies suggesting that patients can be monitored without antibiotics 5.
- The optimal duration of antimicrobial therapy for diverticulitis is not well-defined, with a paucity of data on this topic 6.
Treatment Approaches
Different treatment approaches for diverticulitis are discussed in the studies, including: