Antimicrobial Therapy for Acute Colonic Diverticulitis

Abstract

Background: Although guidelines and reviews have systematically evaluated diagnosis and surgical management of acute diverticulitis, they have focused only minimally on antibiotic selection for the treatment of this disease. We undertook a review of the literature to assess more clearly the use of specific antimicrobial agents in the treatment of patients with acute diverticulitis of the colon. Methods: A MEDLINE search was conducted to identify original research, review papers, and guidelines on the use of antimicrobial agents for the treatment of acute diverticulitis. Results:The general recommendation to use antibiotics with activity against common gram-negative and anaerobic pathogens has remained consistent. A number of single agents and combination regimens provide such activity. However, there is little evidence on which to base selection of specific antimicrobial regimens, and no regimen has demonstrated superiority. In general, episodes of diverticulitis severe enough to warrant hospitalization should be managed initially with intravenous antibiotics. Oral therapy can be used for outpatient treatment or when the patient's condition improves. There is a paucity of data regarding the optimal duration of antimicrobial therapy. Conclusions: Careful clinical studies are needed to evaluate better the antibiotic regimens for the treatment of acute diverticulitis. Until such studies are conducted, we are forced to rely on tradition, in vitro analyses, pharmacokinetic profiling, and indirect evidence from studies of complicated intra-abdominal infections to determine appropriate therapy for this disease.

Changes in the approach to acute diverticulitis

“…The empirical use of antibiotics has long been a cornerstone in the management of AD to treat the localized peritonitis that occurs as a result of diverticular perforation . The understanding has been that any localized inflammation results in microperforation of a diverticulum, with resultant contamination of the peritoneum, either from translocation of colonic bacteria or due to faecal spillage.…”

“…The empirical use of antibiotics has long been a cornerstone in the management of AD to treat the localized peritonitis that occurs as a result of diverticular perforation. 46 The understanding has been that any localized inflammation results in microperforation of a diverticulum, with resultant contamination of the peritoneum, either from translocation of colonic bacteria or due to faecal spillage. Studies of the microbiology of AD have focused on those with peritonitis requiring procedural intervention, 47 and other types of complex intra-abdominal infection have been used as a point of reference when considering appropriate treatment.…”

Geriatrik hastada akut karın ağrısına yaklaşım

“…Amoksisilin-klavulanik asit, sulfametaksazol-trimetoprim ve metronidazol ya da kinolon ve metronidazol kombinasyonları uygun seçeneklerdir. Semptomların düzelmesi 2-3 günü bulabileceği için, hastanın yeniden kontrole çağırılması ve değerlendirilmesi uygun olacaktır (88)(89)(90). Semptomların devamı halinde peridivertiküler apse yanı sıra diğer komplikasyonlar araştırılmalı ve hasta hastaneye yatırılmalıdır.…”

Möglichkeiten und Grenzen der ambulanten Therapie der Divertikelkrankheit

“…Wie beschrieben, folgen die Empfehlungen den mikrobiologischen Ergebnissen, und trotz des internationalen Konsenses sind klassische randomisierte, prospektive, doppelblinde und placebokontrollierte Studien hierzu nur spärlich vorhanden [82].…”