Diverticulitis medical therapy: Difference between revisions
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A 7 to 10 days of oral broad-spectrum antibiotic therapy is tried for acute uncomplicated diverticulitis.<ref>{{Cite book | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 978-0-443-06839-3 | pages = }}</ref> The most common agents used in uncomplicated diverticulitis are: | A 7 to 10 days of oral broad-spectrum antibiotic therapy is tried for acute uncomplicated diverticulitis.<ref>{{Cite book | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 978-0-443-06839-3 | pages = }}</ref> The most common agents used in uncomplicated diverticulitis are: | ||
*[[Quinolone]]-[[metronidazole]] or | *[[Quinolone]]-[[metronidazole]] or | ||
*[[Amoxicillin-clavulanic acid]]or | *[[Amoxicillin-clavulanic acid]] or | ||
*[[Trimethoprim-sulfamethoxazole]] with [[metronidazole]] | *[[Trimethoprim-sulfamethoxazole]] with [[metronidazole]] | ||
Revision as of 16:59, 12 February 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Medical Therapy
Overview
An initial episode of acute diverticulitis is usually treated with conservative medical management, including bowel rest (ie, nothing by mouth), IV fluid resuscitation, and broad-spectrum antibiotics which cover anaerobic bacteria and gram-negative rods. However, recurring acute attacks or complications, such as peritonitis, abscess, or fistula may require surgery, either immediately or on an elective basis.
Upon discharge patients may be placed on a low residue diet. This low-fiber diet gives the colon adequate time to heal without needing to be overworked. Later, patients are placed on a high-fiber diet. There is some evidence this lowers the recurrence rate.
Uncomplicated Diverticulitis
A 7 to 10 days of oral broad-spectrum antibiotic therapy is tried for acute uncomplicated diverticulitis.[1] The most common agents used in uncomplicated diverticulitis are:
- Quinolone-metronidazole or
- Amoxicillin-clavulanic acid or
- Trimethoprim-sulfamethoxazole with metronidazole
Complicated Diverticulitis
In some cases surgery may be required to remove the area of the colon with the diverticula. Patients suffering their first attack of diverticulitis are typically not encouraged to undergo the surgery, unless the case is severe. Patients suffering repeated episodes may benefit from the surgery. In such cases the risks of complications from the diverticulitis outweigh the risks of complications from surgery.
There is no scientific evidence that suggests the avoidance of nuts and seeds prevents the progression of diverticulosis to an acute case of diverticulitis, and as such the widely held belief that small undigestable foods like seeds becoming lodged in the diverticula appears to be nothing more than an 'old wives' tale.[2] Further, in a survey of fellows of The American Society of Colon and Rectal Surgeons, although the majority of the surgeons responding to the survey favored adherence to a low residue diet, half of them still saw no value in specifically avoiding seeds and nuts.[3]
References
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0-443-06839-3.
- ↑ "Patient information: Diverticular disease". UpToDate. Retrieved 2008-02-12.
- ↑ Steven Schechter, Joan Mulvey and Theodore E. Eisenstat (April 1999). "Management of uncomplicated acute diverticulitis". 42 (4): 470–475. doi:10.1007/BF02234169. Retrieved 2008-02-12. Text " Diseases of the Colon & Rectum " ignored (help)