Diverticulitis management

Diverticulitis management

December 2019

You’ll see less focus on antibiotics to treat acute diverticulitis.

DiverticulOSIS usually goes unnoticed…until these small pouches or sacs in the colon wall are found, often during colonoscopy.

It turns into diverticulITIS when the pouches become inflamed or infected and cause lower abdominal pain, nausea, low-grade fever, etc.

Antibiotics have been the mainstay of treatment for years.

Now there’s a push to limit antibiotics in some cases…since diverticulitis is thought to be more of an inflammatory process.

Plus antibiotics don’t seem to reduce complications or recovery time in mild disease…and there are concerns about overuse, Clostridium difficile, etc.

That’s why guidelines recommend watchful waiting for 2 to 3 days in otherwise healthy patients with mild disease and reliable follow-up.

But many patients have already had symptoms at home for a few days before asking for help…and it may not be practical to wait longer.

If needed, suggest a 7-day course of amoxicillin/clavulanate…or TMP/SMX plus metronidazole…for otherwise healthy patients.

A quinolone (ciprofloxacin, etc) plus metronidazole is often used. But advise saving this combo for when other antibiotics aren’t an option…since quinolone adverse effects are piling up.

Expect patients to be treated in the hospital if they’re at high risk (immunocompromised, etc) or have complicated disease (abscess, etc).

Advise patients to follow a clear liquid diet (apple juice, tea, etc) until symptoms improve…and suggest acetaminophen for fever.

Try to avoid NSAIDs…since use can increase flares and risk of perforation or GI bleeding in patients with diverticulitis.

Help prevent future flares. For example, recommend a diet high in fibre and with limited red meat.

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