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Antimicrobials
Antibiotics are adjunctive to source control, which is an absolute necessity. This may be accomplished with surgical debridement or percutaneous catheter drainage, depending on the clinical circumstances. Surgery consultation is strongly encouraged.
The goal of source control is to evacuate devitalized or avascular infected material, define microbiology, and assist with determining the duration of antimicrobial therapy.
Lack of source control is defined as ongoing contamination and/or an undrained collection of infection.
Uncomplicated diverticulitis can usually be managed with antibiotics alone, although up to one-third of patients will have another episode.
Surgery is generally advised after a first attack of complicated diverticulitis or after 2 or more attacks of uncomplicated diverticulitis.
Non-operative management of perforated phlegmonous appendicitis when there is no abscess cavity to drain may be an option; Surgery input is critical.
