Uncomplicated Diverticulitis

Duration of Therapy

7 days

Inpatients with uncomplicated diverticulitis can usually be stepped-down to oral treatment within 2-3 days.

Recommended Empiric Regimen

Ceftriaxone 1g IV Q24H

AND

Metronidazole 500mg PO/IV Q12H

Therapy Pearls

Higher doses of Ceftriaxone add little benefit in localized IAI. 2g IV Q24h is recommended for bacteremia.

Cefazolin is often sufficient, but 10% of E. coli and Klebsiella have higher MICs and "Intermediate" sensitivity. If Cefazolin was started and the patient is clinically improving, changing therapy to Ceftriaxone is not necessary.

Use oral Metronidazole except if non-functioning GI tract or unable to swallow. TID dosing is not necessary for anaerobic bacteria.

Oral Step-Down

Amoxicillin/Clavulanate 875mg PO Q12H

OR

Cefuroxime 500mg PO BID

AND

Metronidazole 500mg PO BID

Alternatives

Sulfamethoxazole/Trimethoprim 1 tab DS PO Q12H and Metronidazole 500mg PO BID

Ciprofloxacin 500mg PO BID with Metronidazole 500mg PO BID (third line due to ADRs/resistance)

Severe Beta-Lactam Allergy

Ciprofloxacin 500mg PO Q12H

AND

Metronidazole 500mg PO Q12H

OR

If non-functioning GI tract and unable to swallow:

Ciprofloxacin 400mg IV Q12H

AND

Metronidazole 500mg IV Q12H