Diverticulitis is an out-pouching in the colon that subsequently becomes inflamed or infected. It can cause diarrhea, constipation, nausea, vomiting, pain, fever or bleeding. The treatment depends upon how severe the symptoms are and if it is the first attack. Mild symptoms may only require a liquid or low-fiber diet, with antibiotics to treat the infection. Any underlying health issues and the severity of the inflammation and infection are considered when determining the treatment protocol.
Broad-Spectrum Oral Antibiotics
The underlying inflammation and infection is initially treated with a broad-spectrum antibiotic that covers anaerobic and gram-negative rod bacteria. According to Johns Hopkins Hospital, diverticulitis infections usually have multiple bacteria, which fall into the category of anaerobic and gram-negative bacilli. Oral antibiotics for an outpatient treatment protocol most often include amoxicillin, ciprofloxacin, moxifloxacin or metronidazole. Patients must take these antibiotics for the prescribed duration of time. Patients should begin to feel better after three to four days, but the infection can return with greater severity if they do not finish the full course of antibiotics.
The American Academy of Family Physicians states that hospitalization and IV antibiotics should be considered if patients show clinical signs of significant inflammation, cannot keep down oral fluids, are greater than 85 years old or have other underlying medical conditions that increase medical risk. Choices of antibiotics are based on broad-spectrum coverage that includes anaerobic and gram-negative bacilli. The IV antibiotics commonly used include Cleocin, a third-generation cephalosporin, such as Mefoxin or Cefotan, or combination drugs, such as Unasyn or Timentin.
Probiotics and Anti-Inflammatory Medications
To prevent further inflammation or infection, probiotics have been considered. In a study published in the "International Journal of Colorectal Disease," researchers Tursi et al discuss the differences between the use of strong anti-inflammatory bowel medications and probiotics, with the intention of reducing recurring symptoms. In their paper, “Balsalazide and/or High Potency Probiotic Mixture (VSL#3) in Maintaining Remission After Attack of Acute, Uncomplicated Diverticulitis of the Colon,” they reveal that the combined use of Balsalazide and probiotics was more effective in preventing recurrent episodes of diverticulitis than either medication used alone.
The pain of diverticulitis often requires the use of pain medication. The Mayo Clinic states that over-the-counter pain relievers, such as acetaminophen, may be enough if the inflammation or infection is mild. When symptoms are more severe or the patient requires hospitalization for treatment, the American Academy of Family Physicians states that the pain medication of choice is Demerol, because it decreases the pressure within the lumen of the intestines. However, opiates, such as Demerol, may also increase the risk of constipation, already a problem with diverticulitis. Patients must report any decrease or change in bowel function when using opiate pain medications.