From the Guidelines
For outpatient treatment of uncomplicated diverticulitis, the recommended antibiotic regimen is typically amoxicillin-clavulanate (Augmentin) 875/125 mg taken orally twice daily for 4-7 days, as this provides adequate coverage against both gram-negative bacteria and anaerobes commonly found in the colon 1. When deciding on antibiotic treatment, it's crucial to consider the patient's overall health status, immune status, severity of presentation, and CT findings. According to the AGA clinical practice update, antibiotics are advised in patients with uncomplicated diverticulitis who have comorbidities, are frail, present with refractory symptoms or vomiting, or have a CRP >140 mg/L or baseline white blood cell count > 15 × 109 cells per liter 1. Key factors to consider when treating diverticulitis outpatient include:
- Patient's immune status, with immunocompromised patients being at higher risk for complications and requiring antibiotic treatment
- Presence of systemic inflammation, abscess, perforation, or obstruction, which necessitate antibiotic treatment
- Baseline ASA score, duration of symptoms, presence of vomiting, CRP levels, and white blood cell count, which can indicate a higher risk of progression to complicated diverticulitis
- CT findings, such as fluid collection or longer segment of inflammation, which can also indicate a higher risk of progression Alternative antibiotic regimens for outpatient treatment of diverticulitis include a combination of an oral fluoroquinolone and metronidazole, which can be used in patients who are unable to tolerate amoxicillin-clavulanate 1. It's essential to note that the duration of antibiotic treatment may vary depending on the patient's response to treatment and the severity of their condition, but is usually 4-7 days 1.
From the Research
Antibiotic Treatment for Outpatient Diverticulitis
- The use of antibiotics for outpatient diverticulitis treatment has been studied in several research papers 2, 3, 4, 5, 6.
- A study published in 2012 found that outpatient treatment with oral antibiotics (Metronidazole and Ciprofloxacin) is viable in almost 95% of patients with uncomplicated acute diverticulitis, with a treatment success rate of 94% and no significant statistical differences in complications and relapse rates compared to inpatient treatment 2.
- Another study published in 2021 compared the effectiveness and harms of metronidazole-with-fluoroquinolone versus amoxicillin-clavulanate for outpatient diverticulitis, and found no differences in 1-year admission risk, urgent surgery risk, or 3-year elective surgery risk between the two groups, but a higher risk of Clostridioides difficile infection with metronidazole-with-fluoroquinolone 3.
- A 2010 study found that ambulatory treatment with oral antibiotics (amoxicillin-clavulanic or ciprofloxacin plus metronidazole) is safe and effective in patients with uncomplicated acute diverticulitis, with a treatment success rate of 97% and only 3% of patients requiring admission 4.
- Guidelines for the management of diverticulitis recommend outpatient treatment for afebrile, clinically stable patients with uncomplicated diverticulitis, with antibiotics used selectively 5.
- A systematic review published in 2016 found that outpatient treatment of uncomplicated diverticulitis is safe, effective, and economically efficient, with a treatment success rate ranging from 91.5 to 100% and fewer than 8% of patients being readmitted to the hospital 6.
Recommended Antibiotics
- Metronidazole and Ciprofloxacin are commonly used antibiotics for outpatient diverticulitis treatment 2, 4.
- Amoxicillin-clavulanate is also a recommended antibiotic for outpatient diverticulitis treatment, with a lower risk of Clostridioides difficile infection compared to metronidazole-with-fluoroquinolone 3.