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Diverticular Disease: Treatment & Medication
Updated: Feb 24, 2010
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- Differential Diagnoses & Workup
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Treatment
Prehospital Care
- Start intravenous fluids and oxygen, particularly during lengthy prehospital periods.
- Scenarios that usually require mobilization of prehospital resources are severe abdominal pain, GI bleeding, or hemodynamic instability with a diagnosis that has not yet been established.
Emergency Department Care
- When a patient presents with classic signs and symptoms of uncomplicated diverticulosis, discharge on antispasmodics and a high-fiber diet with a follow-up sigmoidoscopy at a later time. Typically, no fever, leukocytosis, palpable mass, or other evidence of acute diverticulitis is present.
- For patients who present with signs and symptoms of acute diverticulitis, take the following actions:
- Administer intravenous fluid resuscitation as indicated.
- Give the patient nothing by mouth (NPO).
- In a recent retrospective study, patients who underwent surgical therapy after an initial episode of acute diverticulitis had less recurrence than those who were managed medically.
- Analgesic pain control should be given. Although studies have indicated that analgesics do not mask peritoneal signs, consider general surgery consultation prior to analgesic pain control.
- Insert a nasogastric tube if the patient is vomiting or colonic obstruction is suspected.
- Administer empiric broad-spectrum intravenous (IV) antibiotics. Antibiotics should target anaerobes such as Bacteroides fragilis and Peptostreptococcus, Peptococcus, and Clostridium species, as well as aerobes such as Escherichia coli and Klebsiella, Proteus, Streptococcus, and Enterobacter species. If an abscess is suspected, coverage also should include Pseudomonas aeruginosa.
- Most patients diagnosed with acute diverticulitis should be hospitalized; most improve in 48-72 hours.
- Patients with mild-to-moderate acute diverticulitis and no systemic signs or localized peritonitis may be discharged home on a low-residue food diet and oral antibiotics covering gram-negative organisms and anaerobes. Instruct patients to return if the pain increases or signs of systemic infection develop, assuming the patient is a normal host with no clinical evidence of other morbid conditions requiring admission or additional workup.
- Perform the following if the patient presents with signs and symptoms of acute GI bleeding:
- Address standard ABCs appropriately.
- Administer supplemental oxygen.
- Maintain hemodynamic stability.
- Secure 2 large-bore IV lines.
- Administer lactated Ringer or normal saline solution. Once 2 liters of intravenous fluids are administered, transfuse blood.
- Insert a nasogastric tube to exclude potential upper GI source for the bleeding.
- Search for comorbid conditions such as an acute myocardial infarction from the hypovolemic state.
- Insert a urinary catheter to monitor output, which reflects adequacy of resuscitation.
- Secure the appropriate emergent consultations quickly.
- Admit the patient to an intensive care setting.
- Subsequent management centers on identifying the source of bleeding.
- Diagnosis and treatment guidelines for sigmoid diverticulitis are available from the American Society of Colon and Rectal Surgeons.7
Consultations
Consult with a general surgeon if the patient presents with any of the following:
- Sepsis, fistula, or obstruction
- Clinical evidence of perforation of viscus
- Failure of medical therapy or clinical deterioration
- Inability to exclude carcinoma or recurrence of the disease
- Young age, use of steroids, immunocompromised patients, and right-sided diverticulitis (relative indications for surgical intervention)
Consult for further workup and management as well as the arrangement of follow-up colonoscopy.
Medication
Goals of pharmacotherapy are to treat the infection and prevent complications. Organisms that should be covered by antimicrobial therapy include the following:
- Anaerobes -Bacteroides fragilis, Peptostreptococcus, Clostridium species
- Aerobes -Escherichia coli, Klebsiella, Proteus, Streptococcus, Enterobacter organisms
Typical antimicrobial therapy is divided into inpatient and outpatient regimens.
- Outpatient therapy (one of the following):
- Metronidazole plus ciprofloxacin or levofloxacin or TMP/SMX
- Amoxicillin/clavulanate
- Moxifloxacin
- Inpatient therapy - Mild-to-moderate disease (one of the following):
- Metronidazole plus ciprofloxacin or levofloxacin (intravenous)
- Ampicillin/sulbactam
- Ertapenem
- Piperacillin/tazobactam
- Ticarcillin/clavulanate
- Tigecycline
- Inpatient therapy - Severe disease (one of the following):
- Imipenem
- Doripenem
- Meropenem
- Ampicillin plus metronidazole plus ciprofloxacin or levofloxacin or gentamicin
- For penicillin-allergic patients: Metronidazole plus aztreonam or ciprofloxacin or levofloxacin
Antibiotics
Therapy should cover all likely pathogens in the context of the clinical setting.
Ciprofloxacin (Cipro)
Fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth, by inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic material. Quinolones have broad activity against gram-positive and gram-negative aerobic organisms. Has no activity against anaerobes. Continue treatment for at least 2 d (7-14 d typical) after signs and symptoms have disappeared.
Adult
500 mg or 750 mg PO bid
400 mg IV bid
Pediatric
<18 years: Not recommended
>18 years: Administer as in adults
Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; ciprofloxacin reduces therapeutic effects of phenytoin; probenecid may increase ciprofloxacin serum concentrations
May increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Dosage adjustments (adult adjustments)
CrCl (mL/min) <10: 50% of PO or IV dose q12h
HD: 0.25-0.5 g PO or 0.2-0.4 g IV q12h
During peritoneal dialysis: 0.25-0.5 g PO or 0.2-0.4 g IV q8h
In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy
Not drug of first choice in pediatrics due to increased incidence of adverse events compared with controls, including arthropathy; no data exist for dose for pediatric patients with renal impairment (ie, CrCl <50 mL/min)
Fluoroquinolones are associated with increased risk of tendinitis and tendon rupture in all ages, this risk is further increased in older patients usually >60 y, in patients taking corticosteroid drugs, and in patients with kidney, heart, or lung transplants
Amoxicillin and clavulanate (Augmentin)
Amoxicillin inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. Addition of clavulanate inhibits beta-lactamase producing bacteria.
Good alternative antibiotic for patients allergic or intolerant to the macrolide class. Usually well tolerated and provides good coverage to most infectious agents. Not effective against Mycoplasma and Legionella species. Half-life of oral dosage form is 1-1.3 h. Has good tissue penetration but does not enter cerebrospinal fluid.
For children >3 months, base dosing protocol on amoxicillin content. Because of different amoxicillin/clavulanic acid ratios in 250-mg tab (250/125) vs 250-mg chewable-tab (250/62.5), do not use 250-mg tab until child weighs >40 kg.
Adult
500-875 mg PO q12h or 250-500 mg PO q8h for 7-10 d
Pediatric
<3 months: 125 mg/5 mL PO susp; 30 mg/kg/d (based on amoxicillin component) divided bid for 7-10 d
>3 months: If using 200 mg/5 mL or 400 mg/5 mL susp, 45 mg/kg/d PO divided q12h; if using 125 mg/5 mL or 250 mg/5 mL susp, 40 mg/kg/d PO divided bid for 7-10 d
>40 kg: Administer as in adults
Coadministration with warfarin or heparin increases risk of bleeding; may act synergistically against selected microorganisms when coadministered with aminoglycosides; coadministration with allopurinol may increase incidence of amoxicillin rash; may decrease efficacy of oral contraceptives when administered concomitantly
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Hepatic impairment may occur with prolonged treatment in elderly persons; diarrhea may occur; adjust dose in renal impairment; cross allergy may occur with other beta-lactams and cephalosporins
Ertapenem (Invanz)
Bactericidal activity results from inhibition of cell wall synthesis and is mediated through ertapenem binding to penicillin-binding proteins. Stable against hydrolysis by a variety of beta-lactamases including penicillinases, cephalosporinases, and extended-spectrum beta-lactamases. Hydrolyzed by metallo-beta-lactamases.
Adult
1 g qd for 7- 14 d if IV; infuse over 30 min if IV
CrCl <30 mL/min/1.73 m2: 500 mg IV qd
Pediatric
<3 months: Not established
3 months to 12 years: 15 mg/kg IV q12h; not to exceed 1 g/d
>12 years: Administer as in adults
Probenecid may reduce renal clearance of ertapenem and increase half-life but benefit is minimum and does not justify coadministration
Documented hypersensitivity to drug or amide-type anesthetics
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Pseudomembranous colitis may occur; seizures and CNS adverse reactions may occur; when using with lidocaine to administer intramuscularly, avoid inadvertent injection into blood vessel; decrease dose in renal failure; serious and occasionally fatal hypersensitivity reactions may occur with beta-lactams; caution with previous hypersensitivity reactions to penicillin, cephalosporins, other beta-lactams, or other allergens; do not mix or co-infuse in same IV line as other medications; do not mix with dextrose-containing diluents
Gentamicin sulfate
Aminoglycoside antibiotic for gram-negative coverage bacteria including Pseudomonas species. Synergistic with beta-lactamase against enterococci. Interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits.
Dosing regimens are numerous and are adjusted based on CrCl and changes in volume of distribution, as well as body space into which agent needs to distribute. Dose of gentamicin may be given IV/IM. Each regimen must be followed by at least trough level drawn on third or fourth dose, 0.5 h before dosing; may draw peak level 0.5 h after 30-min infusion.
Adult
5 mg/kg IV/IM qd
Pediatric
<5 years: 2.5 mg/kg/dose IV/IM q8h
>5 years: 1.5-2.5 mg/kg/dose IV/IM q8h or 6-7.5 mg/kg/d divided q8h; not to exceed 300 mg/d; monitor as in adults
Coadministration with other aminoglycosides, cephalosporins, penicillins, and amphotericin B may increase nephrotoxicity; because aminoglycosides enhance effects of neuromuscular blocking agents prolonged respiratory depression may occur; coadministration with loop diuretics may increase auditory toxicity of aminoglycosides; possible irreversible hearing loss of varying degrees may occur (monitor regularly)
Documented hypersensitivity; non-dialysis dependent renal insufficiency
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Narrow therapeutic index (not intended for long-term therapy); caution in renal failure (not on dialysis), myasthenia gravis, hypocalcemia, and conditions that depress neuromuscular transmission; adjust dose in renal impairment
Tigecycline (Tygacil)
A glycylcycline antibiotic that is structurally similar to tetracycline antibiotics. Inhibits bacterial protein translation by binding to 30S ribosomal subunit, and blocks entry of amino-acyl tRNA molecules in ribosome A site. Complicated intra-abdominal infections caused by C freundii, E cloacae, E coli, K oxytoca, K pneumoniae, E faecalis (vancomycin-susceptible isolates only), S aureus (methicillin-susceptible isolates only), S anginosus group. (includes S anginosus, S intermedius, and S constellatus), B fragilis, B thetaiotaomicron, B uniformis, B vulgatus, C perfringens, and P micros.
Adult
Infuse each dose over 30-60 min
100 mg IV once, then 50 mg IV q12h
Severe hepatic impairment (ie, Child Pugh class C): 100 mg IV once, then 25 mg IV q12h
Pediatric
<18 years: Not established
>18 years: Administer as in adults
Coadministration decreases warfarin clearance and increases warfarin Cmax and AUC (monitor aPTT and INR); coadministration of antibiotics with oral contraceptives may decrease contraceptive effect
Documented hypersensitivity
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in severe hepatic impairment (reduce dose); may adversely effect tooth development; may permit clostridia overgrowth, resulting in antibiotic-associated colitis; may have adverse effects similar to tetracyclines (eg, photosensitivity, pseudotumor cerebri, pancreatitis, antianabolic action)
Imipenem and cilastatin (Primaxin)
For treatment of multiple organism infections in which other agents do not have wide-spectrum coverage or are contraindicated due to potential for toxicity.
Adult
Base initial dose on severity of infection, and administer in equally divided doses; dose may range from 250-500 mg q6h IV for a maximum of 3-4 g/d
Alternatively, 500-750 mg q12h IM or intra-abdominally
Pediatric
Infants >3 months and children
<12 years: 15-25 mg/kg/dose IV q6h
Fully susceptible organisms: Not to exceed 2 g/d
Infections with moderately susceptible organisms: Not to exceed 4 g/d
>12 years: Administer as in adults
Coadministration with cyclosporine may increase CNS side effects of both agents; coadministration with ganciclovir may result in generalized seizures
Documented hypersensitivity; known hypersensitivity to amide local anesthetics; children with CNS infections (increased seizure risk); children <30 kg with renal impairment (lack of data)
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Adjust dose in renal insufficiency (adult adjustments)
CrCl (mL/min) 80-50: 0.5 g q6-8h
CrCl 50-10: 0.5 g q8-12h
Hemodialysis (HD): 0.25-0.5 g after HD, then q12h
Adjust dose in renal insufficiency; avoid use in children <12 y with CNS infections
Caution with history of seizures, hypersensitivity to penicillins, cephalosporins, or other beta-lactam antibiotics
Doripenem (Doribax)
Carbapenem antibiotic. Elicits activity against a wide range of gram-positive and gram-negative bacteria. Indicated as a single agent for complicated intra-abdominal infections caused by susceptible strains of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacteroides caccae, Bacteroides fragilis, Bacteroides thetaiotaomicron, Bacteroides uniformis, Bacteroides vulgatus, Streptococcus intermedius, Streptococcus constellatus, and Peptostreptococcus micros.
Adult
500 mg IV q8h infused over 1 h
CrCl> 50: No dosage adjustment necessary
CrCl≥ 30 to ≤ 50: 250 mg IV q8h
CrCl> 10 to < 30: 250 mg IV q12h
Pediatric
<18 years: Not established
>18 years: Administer as in adults
Carbapenems may decrease valproic acid serum concentration, causing increased seizure risk; probenecid reduces renal clearance of doripenem, resulting in increased doripenem concentration; does not inhibit or induce major CYP450 enzymes
Documented hypersensitivity to doripenem or other carbapenems or demonstrated anaphylactic reactions to beta-lactams
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Clostridium difficile –associated diarrhea has been reported with nearly all antibacterial agents and must be considered if patient presents with diarrhea; common adverse effects (ie, >5%) include headache, nausea, diarrhea, rash, and phlebitis; decrease dose with renal insufficiency
Aztreonam (Azactam)
A monobactam, not a beta-lactam antibiotic that inhibits cell wall synthesis during bacterial growth. Active against gram-negative bacilli but very limited gram-positive activity and not useful for anaerobes. Lacks cross-sensitivity with beta-lactam antibiotics. May be used in patients allergic to penicillins or cephalosporins.
Duration of therapy depends on severity of infection and continued for at least 48 h after patient asymptomatic or evidence of bacterial eradication obtained. Doses smaller than indicated should not be used.
Transient or persistent renal insufficiency may prolong serum levels. After initial loading dose of 1 or 2 g, reduce dose by one half for estimated ClCr of 10-30 mL/min/1.73 m2. When only serum creatinine concentration available, the following formula (based on sex, weight, and age) can approximate ClCr. Serum creatinine should represent a steady state of renal function.
Males: ClCr = [(weight in kg)(140 - age)] divided by (72 X serum creatinine in mg/dL)
Females: 0.85 X above value
In patients with severe renal failure (ClCr <10 mL/min/1.73 m2), those supported by hemodialysis, usual dose of 500 mg, 1 g, or 2 g, is given initially.
Maintenance dose is one fourth of usual initial dose given at usual fixed interval of 6, 8, or 12 h.
For serious or life-threatening infections, supplement maintenance doses with one-eighth of initial dose after each hemodialysis session.
Elderly persons may have diminished renal function. Renal status is a major determinant of dosage in these patients. Serum creatinine level may not be an accurate determinant of renal status. Therefore, as with all antibiotics eliminated by kidneys, obtain estimates of ClCr, and make appropriate dosage modifications. Insufficient data are available regarding IM administration to pediatric patients or dosing in pediatric patients with renal impairment. Administered IV only to pediatric patients with normal renal function.
Adult
500-2000 mg IV/IM q6-8h
Pediatric
90-120 mg/kg/d IV/IM divided q6-8h
Tetracyclines may reduce effects
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal insufficiency
Metronidazole (Flagyl)
Active against various anaerobic bacteria. Enters cell, binds DNA, and inhibits protein synthesis, causing cell death.
Adult
500 mg PO/IV qid
Pediatric
<12 years: Not established
>12 years: Administer as in adults
May increase toxicity of anticoagulants, cyclosporine, lithium, phenytoin, tacrolimus, and carbamazepine; cimetidine may increase toxicity of metronidazole; disulfiram reaction may occur with orally ingested ethanol; coadministration increases amiodarone toxicity (QT prolongation); increases disulfiram toxicity (psychotic symptoms) with concurrent use; phenobarbital and rifampin may increase metabolism of metronidazole
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution with liver impairment, blood dyscrasias, CNS disease; reduce dosage with severe hepatic disease; monitor for seizures and development of peripheral neuropathy
Piperacillin and tazobactam sodium (Zosyn)
Antipseudomonal penicillin plus beta-lactamase inhibitor. Inhibits biosynthesis of cell wall mucopeptide and is effective during stage of active multiplication.
Adult
3/0.375 g (piperacillin 3 g and tazobactam 0.375 g) IV q6h
Pediatric
<12 years: Not established
>12 years: Administer as in adults
Tetracyclines may decrease effects of piperacillin; high concentrations of piperacillin may physically inactivate aminoglycosides if administered in same IV line; effects when administered concurrently with aminoglycosides are synergistic; probenecid may increase penicillin levels; high-dose parenteral penicillins may result in increased risk of bleeding
Documented hypersensitivity; severe pneumonia, bacteremia, pericarditis, emphysema, meningitis, and purulent or septic arthritis should not be treated with an oral penicillin during the acute stage
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Perform CBCs prior to initiation of therapy and at least weekly during therapy; monitor for liver function abnormalities by measuring AST and ALT during therapy; exercise caution in patients diagnosed with hepatic insufficiencies; perform urinalysis, and BUN and creatinine determinations during therapy and adjust dose if values become elevated; monitor blood levels to avoid possible neurotoxic reactions
Levofloxacin (Levaquin)
For pseudomonal infections and infections due to multidrug resistant gram-negative organisms.
Adult
500-750 mg PO/IV qd for 7-14 d
Pediatric
<18 years: Not recommended
>18 years: Administer as in adults
Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; levofloxacin reduces therapeutic effects of phenytoin; probenecid may increase levofloxacin serum concentrations
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy
Moxifloxacin (Avelox)
Inhibits the A subunits of DNA gyrase, resulting in inhibition of bacterial DNA replication and transcription.
Adult
400 mg PO/IV qd
Pediatric
<18 years: Not recommended
>18 years: Administer as in adults
Antacids, electrolyte supplements reduce absorption; loop diuretics, probenecid, cimetidine increase serum levels; NSAIDs enhance CNS stimulating effect
May increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT); ferrous sulfate decreases bioavailability (administer moxifloxacin 4 h prior or 8 h following ferrous sulfate); coadministration with drugs that prolong QTc interval (quinidine, procainamide, amiodarone, sotalol, erythromycin, tricyclic antidepressants) increase risk of life-threatening arrhythmia
Documented hypersensitivity; known QT prolongation, concurrent administration of drugs that cause QT prolongation
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); superinfections may occur with prolonged or repeated antibiotic therapy; fluoroquinolones have induced seizures in CNS disorders and caused tendinitis or tendon rupture
Ticarcillin and clavulanate potassium (Timentin)
Inhibits biosynthesis of cell wall mucopeptide and is effective during stage of active growth.
Antipseudomonal penicillin plus beta-lactamase inhibitor that provides coverage against most gram-positive organisms, most gram-negative organisms, and most anaerobes.
Adult
3.1 g IV q4-6h
Pediatric
75 mg/kg IV q6h
Tetracyclines may decrease effects of ticarcillin; high concentrations of ticarcillin may physically inactivate aminoglycosides if administered in same IV line; effects when administered concurrently with aminoglycosides are synergistic; probenecid may increase penicillin levels
Documented hypersensitivity; severe pneumonia, bacteremia, pericarditis, emphysema, meningitis, and purulent or septic arthritis should not be treated with oral penicillin during acute stage
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Perform CBCs prior to initiation of therapy and at least weekly during therapy; monitor for liver function abnormalities by measuring AST and ALT during therapy; exercise caution in patients diagnosed with hepatic insufficiencies; perform urinalysis, and BUN and creatinine determinations during therapy and adjust dose if values become elevated; monitor blood levels to avoid possible neurotoxic reactions
Meropenem (Merrem I.V.)
Bactericidal broad-spectrum carbapenem antibiotic that inhibits cell wall synthesis. Effective against most gram-positive and gram-negative bacteria.
Has slightly increased activity against gram-negatives and slightly decreased activity against staphylococci and streptococci compared with imipenem.
Adult
1 g IV q8h
Pediatric
40 mg/kg IV q8h
Probenecid may inhibit renal excretion of meropenem, increasing meropenem levels
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Dosage adjustments (adult adjustments)
CrCl (mL/min) 10-50: 0.5-1 g q12h
CrCl <10: 0.5 g/d
HD: As for CrCl <10, with an extra 0.5 g after HD
Pseudomembranous colitis and thrombocytopenia may occur, requiring immediate discontinuation of medication
Ampicillin (Principen)
Broad-spectrum penicillin. Interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. Alternative to amoxicillin when unable to take medication orally.
Until recently, the HACEK bacteria were uniformly susceptible to ampicillin. Recently, however, beta-lactamase–producing strains of HACEK have been identified.
Adult
2 g IV q6h; not to exceed 12 g/d
Pediatric
50-100 mg/kg/d PO divided q4-6h
100-400 mg/kg/d IV/IM divided q4-6h
Probenecid and disulfiram elevate ampicillin levels; allopurinol decreases ampicillin effects and has additive effects on ampicillin rash; may decrease effects of oral contraceptives
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal failure; evaluate rash and differentiate from hypersensitivity reaction
More on Diverticular Disease |
| Overview: Diverticular Disease |
| Differential Diagnoses & Workup: Diverticular Disease |
 Treatment & Medication: Diverticular Disease |
| Follow-up: Diverticular Disease |
| Multimedia: Diverticular Disease |
| References |
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Further Reading
Keywords
diverticular disease, diverticulitis, acute diverticulitis, diverticulosis, lower gastrointestinal bleeding, lower GI bleeding, Meckel iliac diverticulum, congenital diverticula, peridiverticular inflammation, tenesmus, recurrent urinary tract infections, colovesicular fistulas, pneumaturia, feculent vaginal discharge, colonic segmentation, defects in colonic wall strength
