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Diverticulitis Empiric Therapy 

  • Author: Samy A Azer, MD, PhD, MPH; Chief Editor: BS Anand, MD  more...
 
Updated: Jun 11, 2016
 

Empiric Therapy Regimens

Diverticulitis can be classified as mild, moderate, or severe. Treatment is based on clinical findings and the results of imaging studies. The mainstay of treatment includes antibiotic therapy, bowel rest, and analgesia.[1, 2, 3, 4, 5, 6, 7]

Mild to moderate diverticulitis

In mild to moderate diverticulitis, localized symptoms are present without evidence of perforation, abscess, or significant comorbidity. Patients can be managed on an outpatient basis with close follow-up. Treatment also includes a clear liquid diet for 3-5d.

Treatment recommendations:

Severe diverticulitis

Severe diverticulitis may include focal or generalized peritonitis, peridiverticular abscess, and systemic signs of sepsis. Inpatient treatment is recommended; surgical intervention may be required. Supportive care includes bowel rest; IV fluids; correction of electrolyte imbalance; and parenteral nutrition, if necessary.

Treatment recommendations:

  • Ciprofloxacin 400mg IV q12h plus  metronidazole 500mg IV q6h or 1g IV q12h or
  • Levofloxacin 750mg IV q24h plus  metronidazole 500mg IV q6h or 1g IV q12h or
  • Ceftriaxone 1-2g IV q24h plus  metronidazole 500mg IV q6h or
  • Ceftolozane/tazobactam 1.5 g IV q8h plus  metronidazole 500 mg IV q8h or
  • Ampicillin-sulbactam 3g IV q6h or
  • Ampicillin 2g IV q6h plus  metronidazole 500mg IV q6h plus ciprofloxacin 400mg IV q12h or levofloxacin 750mg IV q24h
  • Ampicillin 2g IV q6h plus  metronidazole 500mg IV q6h plus amikacin, gentamicin, or tobramicin
  • Piperacillin-tazobactam 3.375g IV q6h or 4.5g IV q8h or
  • Ticarcillin-clavulanate 3.1g IV q6h or
  • Ertapenem 1g IV q24h or
  • Imipenem/cilastatin 500mg IV q6h or
  • Meropenem 1g IV q8h or
  • Doripenem 500mg IV q8h or
  • Tigecycline 100mg IV first dose, then 50mg IV q12h
  • Duration of therapy: 7d
 
Contributor Information and Disclosures
Author

Samy A Azer, MD, PhD, MPH Professor of Medical Education, Chair of Medical Education Research and Development Unit, Faculty of Medicine, Universiti Teknologi MARA, Malaysia; Visiting Professor of Medical Education, Faculty of Medicine, University of Toyama, Japan; Former Senior Lecturer in Medical Education, Faculty Education Unit, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne and University of Sydney, Australia

Samy A Azer, MD, PhD, MPH is a member of the following medical societies: New York Academy of Sciences, Sigma Xi, Association for Psychological Science, Gastroenterological Society of Australia, American College of Gastroenterology, Royal Society of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of Ohio, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References
  1. Faria GR, Almeida AB, Moreira H, Pinto-de-Sousa J, Correia-da-Silva P, Pimenta AP. Acute diverticulitis in younger patients: any rationale for a different approach?. World J Gastroenterol. 2011 Jan 14. 17(2):207-12. [Medline].

  2. Masoomi H, Buchberg BS, Magno C, Mills SD, Stamos MJ. Trends in diverticulitis management in the United States from 2002 to 2007. Arch Surg. 2011 Apr. 146(4):400-6. [Medline].

  3. Hemming J, Floch M. Features and management of colonic diverticular disease. Curr Gastroenterol Rep. 2010 Oct. 12(5):399-407. [Medline].

  4. Chautems RC, Ambrosetti P, Ludwig A, Mermillod B, Morel P, Soravia C. Long-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory?: a prospective study of 118 patients. Dis Colon Rectum. 2002 Jul. 45(7):962-6. [Medline].

  5. Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010 Jan 15. 50(2):133-64. [Medline].

  6. Wilkins T, Embry K, George R. Diagnosis and management of acute diverticulitis. Am Fam Physician. 2013 May 1. 87(9):612-20. [Medline].

  7. Feingold D, Steele SR, Lee S, et al. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum. 2014 Mar. 57(3):284-94. [Medline]. [Full Text].

 
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