Answer
Severe diverticulitis may include focal or generalized peritonitis, peridiverticular abscess, and systemic signs of sepsis. Inpatient treatment is recommended; surgical intervention may be required. Supportive care includes bowel rest; IV fluids; correction of electrolyte imbalance; and parenteral nutrition, if necessary.
Treatment recommendations:
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Ciprofloxacin 400mg IV q12h plus metronidazole 500mg IV q6h or 1g IV q12h or
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Levofloxacin 750mg IV q24h plus metronidazole 500mg IV q6h or 1g IV q12h or
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Ceftriaxone 1-2g IV q24h plus metronidazole 500mg IV q6h or
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Ceftolozane/tazobactam 1.5 g IV q8h plus metronidazole 500 mg IV q8h or
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Ampicillin-sulbactam 3g IV q6h or
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Ampicillin 2g IV q6h plus metronidazole 500mg IV q6h plus ciprofloxacin 400mg IV q12h or levofloxacin 750mg IV q24h
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Ampicillin 2g IV q6h plus metronidazole 500mg IV q6h plus amikacin, gentamicin, or tobramicin
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Piperacillin-tazobactam 3.375g IV q6h or 4.5g IV q8h or
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Ticarcillin-clavulanate 3.1g IV q6h or
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Ertapenem 1g IV q24h or
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Imipenem/cilastatin 500mg IV q6h or
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Meropenem 1g IV q8h or
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Doripenem 500mg IV q8h or
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Tigecycline 100mg IV first dose, then 50mg IV q12h
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Duration of therapy: 7d
