Diverticulitis medical therapy: Difference between revisions
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*[[Trimethoprim-sulfamethoxazole]] with [[metronidazole]] | *[[Trimethoprim-sulfamethoxazole]] with [[metronidazole]] | ||
Admission to the hospital is indicated in all patients who are elderly, those with compromised immune systems,other comorbidities, cannot tolerate oral hydration,or fails to improve despite appropriate antibiotic therapy. The aim of hospital admission is bowel rest, nasogastric tube placement, and parenteral antibiotics.<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> | Admission to the hospital is indicated in all patients who are elderly, those with compromised immune systems,other comorbidities, cannot tolerate oral hydration,or fails to improve despite appropriate antibiotic therapy. The aim of hospital admission is bowel rest, nasogastric tube placement, and parenteral antibiotics.<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> | ||
Outpatients should be advised to use diet consist of liquids only for 2-3 days, after which the diet can be resumed slowly. hospitalized patients can be treated with either liquids, or NPO with intravenous hydration depending on the severity. | |||
The advice to avoid seeds and nuts because they may become impacted in a diverticulum is unproven, and of no value.<ref name="pmid10215046">{{cite journal| author=Schechter S, Mulvey J, Eisenstat TE| title=Management of uncomplicated acute diverticulitis: results of a survey. | journal=Dis Colon Rectum | year= 1999 | volume= 42 | issue= 4 | pages= 470-5; discussion 475-6 | pmid=10215046 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10215046 }} </ref> | |||
===Complicated Diverticulitis=== | ===Complicated Diverticulitis=== | ||
Revision as of 19:43, 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
Admission to the hospital is indicated in all patients who are elderly, those with compromised immune systems,other comorbidities, cannot tolerate oral hydration,or fails to improve despite appropriate antibiotic therapy. The aim of hospital admission is bowel rest, nasogastric tube placement, and parenteral antibiotics.[2]
Outpatients should be advised to use diet consist of liquids only for 2-3 days, after which the diet can be resumed slowly. hospitalized patients can be treated with either liquids, or NPO with intravenous hydration depending on the severity. The advice to avoid seeds and nuts because they may become impacted in a diverticulum is unproven, and of no value.[3]
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.[4] 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.[5]
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.
- ↑ 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.
- ↑ Schechter S, Mulvey J, Eisenstat TE (1999). "Management of uncomplicated acute diverticulitis: results of a survey". Dis Colon Rectum. 42 (4): 470–5, discussion 475-6. PMID 10215046.
- ↑ "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)