Table 9 --Treatment of Diverticular Disease

Treatment

Painful Diverticulosis

Diverticulitis

Diet

Increase fiber

Reduce fiber (or nothing by mouth)

Bulk laxatives

Probably effective

Not indicated

Narcotic analgesics

Not indicated

Indicated

Antispasmodics*

Propantheline bromide;

Dicyclomine hydrochloride

Not indicated

Antibiotics

Not indicated

Oral (choice 7-10d)

  • Amoxicillin-clavulanate
    potassium (875 mg tid)

  • Ciprofloxacin (500 mg bid) plus metronidazole (250 mg qid)

Parenteral (choice)

  • Ampicillin/sulbactam sodium (6 -12 g/d)

  • Gentamicin or tobramycin (5 mg/kg/d)
    plus clindamycin (1.2 - 2.4 g/d)
    or metronidazole (500 mg q 6 h)

  • Cefoxitin ( 1 - 2 gm q 6 - 8 h) (4 - 6 g/d)


* =Possibly effective

Source: Gastroenterology and Hepatology MKSAP, 2nd Edition, 1997. Castell DO, ed. American College of Physicians, Philadelphia, p 107.