From the Guidelines
Diverticulitis treatment should prioritize a selective approach to antibiotic use, reserving them for patients with complicated diverticulitis, those with comorbidities, or those presenting with severe symptoms, as recommended by the most recent guidelines from the American College of Physicians 1.
Key Considerations
- The use of antibiotics in uncomplicated diverticulitis has been reevaluated, with evidence suggesting that they may not be necessary for all patients, particularly those who are immunocompetent and have mild symptoms 1.
- Patients with uncomplicated diverticulitis can often be managed in an outpatient setting, with supportive care including bowel rest and hydration, unless they have predictors of progression to complicated disease or require close monitoring 1.
- The decision to use antibiotics should be based on individual patient factors, including the presence of comorbidities, severity of symptoms, and laboratory findings such as CRP levels and white blood cell count 1.
- For patients who do require antibiotics, oral broad-spectrum agents with gram-negative and anaerobic coverage, such as ciprofloxacin plus metronidazole or amoxicillin-clavulanate, are commonly recommended for 4-7 days, depending on the severity of the disease and patient response 1.
Management Approach
- Outpatient management is suitable for most patients with uncomplicated diverticulitis, provided they can be closely monitored and have adequate support at home 1.
- Antibiotic therapy should be tailored to the individual patient, considering factors such as the severity of disease, presence of complications, and patient comorbidities 1.
- Dietary modifications, including a clear liquid diet initially followed by a gradual introduction of solid foods, and long-term adherence to a high-fiber diet, are crucial for managing symptoms and preventing recurrence 1.
- Pain management with acetaminophen or other analgesics as needed is an important component of treatment, ensuring patient comfort and reducing the risk of complications associated with severe pain.
From the Research
Diverticulitis Treatment Overview
- Diverticulitis treatment depends on the severity of symptoms and classification of the disease as uncomplicated or complicated 2, 3
- Uncomplicated diverticulitis can be treated without antibiotics, without bed rest, and without dietary restrictions, and a selected group of patients can be treated as outpatients 3, 4
- Complicated diverticulitis requires non-operative management, including bowel rest and intravenous antibiotics, or surgical intervention in severe cases 2, 5
Diagnosis and Classification
- Radiological evidence of inflammation using computed tomography (CT) is needed to diagnose the first occurrence of diverticulitis 2
- CT scan, severity of symptoms, and patient history are used to classify diverticulitis as uncomplicated or complicated 2
Treatment Options
- Outpatient treatment is recommended for afebrile, clinically stable patients with uncomplicated diverticulitis 2, 4
- Antibiotics have no proven benefit in reducing the duration of the disease or preventing recurrence in uncomplicated diverticulitis and should only be used selectively 2, 3, 6
- Non-operative management, including bowel rest and intravenous antibiotics, is indicated for small abscesses, while larger abscesses should be drained percutaneously 2
- Surgical intervention is indicated for peritonitis, sepsis, or failure of non-operative management 2, 5
Follow-up and Prevention
- Colonoscopy is recommended for all patients with complicated diverticulitis 6 weeks after CT diagnosis of inflammation, and for patients with uncomplicated diverticulitis who have suspicious features on CT scan or who otherwise meet national bowel cancer screening criteria 2
- The use of mesalazine, rifaximin, and probiotics has been studied, but their efficacy in preventing recurrent diverticulitis is uncertain 3