How is severe diverticulitis treated?

Updated: May 05, 2020
  • Author: Samy A Azer, MD, PhD, MPH; Chief Editor: BS Anand, MD  more...
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Answer

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:

  • Ciprofloxacin 400mg IV q12h plus  metronidazole 500mg IV q6h or 1g IV q12h or

  • Levofloxacin 750mg IV q24h plus  metronidazole 500mg IV q6h or 1g IV q12h or

  • Ceftriaxone 1-2g IV q24h plus  metronidazole 500mg IV q6h or

  • Ceftolozane/tazobactam 1.5 g IV q8h plus  metronidazole 500 mg IV q8h or

  • Ampicillin-sulbactam 3g IV q6h or

  • Ampicillin 2g IV q6h plus  metronidazole 500mg IV q6h plus ciprofloxacin 400mg IV q12h or levofloxacin 750mg IV q24h

  • Ampicillin 2g IV q6h plus  metronidazole 500mg IV q6h plus amikacin, gentamicin, or tobramicin

  • Piperacillin-tazobactam 3.375g IV q6h or 4.5g IV q8h or

  • Ticarcillin-clavulanate 3.1g IV q6h or

  • Ertapenem 1g IV q24h or

  • Imipenem/cilastatin 500mg IV q6h or

  • Meropenem 1g IV q8h or

  • Doripenem 500mg IV q8h or

  • Tigecycline 100mg IV first dose, then 50mg IV q12h

  • Duration of therapy: 7d


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