Diverticulitis is the inflammation of diverticula in the colon and is classified as uncomplicated or complicated. Uncomplicated diverticulitis involves localized inflammation without associated complications, while complicated diverticulitis includes abscess, perforation, fistula, or obstruction.
Uncomplicated Diverticulitis:
Antibiotic Use: Recent guidelines suggest that antibiotics can be used selectively rather than routinely in immunocompetent patients with mild uncomplicated diverticulitis. Antibiotics are advised for patients with comorbidities, frailty, refractory symptoms, vomiting, elevated inflammatory markers (CRP >140 mg/L), or baseline WBC >15. American Gastroenterological Association
Diet: A clear liquid diet is recommended during the acute phase, with gradual advancement as symptoms improve.
Complicated Diverticulitis:
Oral Antibiotic Therapy: Empiric regimens should cover gram-negative rods and anaerobic bacteria. Commonly used oral antibiotics include:
Amoxicillin-Clavulanate: 875 mg/125 mg orally twice daily.
Metronidazole: 500 mg orally three times daily, combined with either:
Ciprofloxacin: 500 mg orally twice daily, or
Trimethoprim-Sulfamethoxazole: 160 mg/800 mg (one double-strength tablet) orally twice daily.
The typical duration of antibiotic therapy is 7 to 10 days, but the exact duration should be individualized based on clinical response. AAFP
- IV Antibiotic Therapy AAFP
Monotherapy Options:
- Piperacillin-Tazobactam: 3.375 grams IV every 6 hours.
- Ertapenem: 1 gram IV once daily.
- Moxifloxacin: 400 mg IV every 24 hours.
Combination Therapy:
- Ceftriaxone: 2 grams IV once daily, or
- Cefotaxime: 2 grams IV every 8 hours,
- PLUS Metronidazole: 500 mg IV every 8 hours
Follow-Up:
- Colonoscopy: After an episode of diverticulitis, a colonoscopy is advised to exclude other conditions such as colonic neoplasm. This should be performed after complete resolution of acute symptoms, typically delayed by 6-8 weeks.
Lifestyle Modifications:
- Diet and Lifestyle: To reduce the risk of recurrence, patients are advised to consume a high-quality diet, maintain a normal body mass index, engage in regular physical activity, and avoid smoking. Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided, except for aspirin prescribed for secondary prevention of cardiovascular disease.
