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, 8] The American Gastroenterological Association (AGA) suggests selective, rather than routine, use of antibiotics in patients with acute uncomplicated diverticulitis. [9, 10]
Mild to moderate diverticulitis
In mild to moderate diverticulitis, localized symptoms are present without any evidence of perforation, abscess, or significant comorbidity. Patients can be managed on an outpatient basis with close follow-up. [11] Treatment also includes a clear liquid diet for 3-5 days and oral antibiotics. If there is no improvement in 2-3 days, the patient should be admitted for further workup.
Treatment recommendations:
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Trimethoprim-sulfamethoxazole (160mg/800mg) 1 DS tablet PO BID plus metronidazole 500mg PO QID or
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Ciprofloxacin 750mg PO BID plus metronidazole 500mg PO QID or
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Levofloxacin 750 mg PO daily plus metronidazole 500mg PO QID or
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Amoxicillin-clavulanate (875mg/125mg) PO BID or amoxicillin-clavulanate extended release (1,000mg/62.5mg) PO BID or
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Moxifloxacin 400mg PO daily
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Duration of therapy: 7-10d
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:
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Ciprofloxacin 400mg IV q12h plus metronidazole 500mg IV q6h or 1g IV q12h or
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Levofloxacin 750mg IV q24h plus metronidazole 500mg IV q6h or 1g IV q12h or
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Ceftriaxone 1-2g IV q24h plus metronidazole 500mg IV q6h or
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Ceftolozane/tazobactam 1.5 g IV q8h plus metronidazole 500 mg IV q8h or
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Ampicillin-sulbactam 3g IV q6h or
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Ampicillin 2g IV q6h plus metronidazole 500mg IV q6h plus ciprofloxacin 400mg IV q12h or levofloxacin 750mg IV q24h
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Ampicillin 2g IV q6h plus metronidazole 500mg IV q6h plus amikacin, gentamicin, or tobramicin
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Piperacillin-tazobactam 3.375g IV q6h or 4.5g IV q8h or
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Ticarcillin-clavulanate 3.1g IV q6h or
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Ertapenem 1g IV q24h or
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Imipenem/cilastatin 500mg IV q6h or
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Meropenem 1g IV q8h or
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Doripenem 500mg IV q8h or
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Tigecycline 100mg IV first dose, then 50mg IV q12h
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Duration of therapy: 7d
