Treatment-diverticulitis

(JAMA 2017;318:291; NEJM 2018;379:1635; Gastro 2021;160:906)

• Mild: outPt Rx indicated if Pt has few comorbidities and can tolerate POs PO abx: (MNZ + FQ) or amox/clav for 7 d; liquid diet until clinical improvement

No abx is noninferior to abx in uncomplicated diverti (Clin Gastroenterol Hepatol 2021;19:503)

• Severe: inPt Rx if cannot take POs, narcotics needed for pain, or complications

NPO, IVF, NGT (if ileus); IV abx (GNR & anaerobic coverage; eg, CTX/MNZ or pip-tazo)

• Abscesses >4 cm should be drained percutaneously or surgically

• Surgery: if progression despite med Rx, undrainable abscess, free perforation

After source control, 4 d abx may be sufficient (NEJM 2015;372:1996)

Resection for recurrent bouts of diverticulitis on a case-by-case basis Consider lower threshold for urgent & elective surgery for immunocompromised Pts