Spectrum: Local Antimicrobial Stewardship, for Island Health

Outpatient Diverticulitis

Consider No Antibiotic Treatment

Recent studies and guidelines question the utility of antibiotics

Antibiotics compared to hydration did not:

  • prevent complications

  • resolve symptoms faster

  • prevent hospitalization

  • reduce recurrence

Therapy should be offered to certain outpatients

  • immunosuppressed

  • pregnant women

  • those with Pelvic Inflammatory Disease

  • those with significant co-morbidities

Duration of Therapy

7 days

If treating, 5-10 days have been cited; can reassess in 2-3 days after initiation and tailor based on response

Recommended Empiric Regimen

Amoxicillin/Clavulanate 875mg PO BID

OR

Cefuroxime 500mg PO BID

AND

Metronidazole 500mg PO BID

Alternatives

Sulfamethoxazole/Trimethoprim DS 1 tab BID with Metronidazole 500mg PO BID

Ciprofloxacin 500mg PO BID with Metronidazole 500mg PO BID

Therapy Pearls

If no antibiotics prescribed, re-assess in 48 hours

Higher doses of Metronidazole are not necessary for coverage of anaerobic bacteria

Ciprofloxacin-based regimen considered third line due to possible ADRs and resistance, but provide a potent oral option for those otherwise needing IV