Start with a free account for 3 free CME credits. Already a subscriber? Sign in.

What Would I Do Next | Diverticulitis

Matthew DeLaney, MD and Mizuho Morrison, DO
00:00
20:41
Sign in or subscribe to listen

No me gusta!

The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

Miz and Delaney review the definition and pathophysiology of diverticulitis. They discuss its clinical presentation. They review diagnosis and treatment/management as well as complications of diverticulitis.

To view chapter written summaries, you need to subscribe.

Sign up today for full access to all episodes.

Susan N., PA-C -

Hi! Thanks for the great segment. I also have been looking into alternatives to fluoroquinolones for treatment. I have been using Augmentin as well however according to UpToDate the treatment dosage recommended is:
Amoxicillin-clavulanate (1 tablet [875 mg amoxicillin; 125 mg clavulanic acid] every 8 hours) or Augmentin XR (2 tablets [each tablet containing 1 g amoxicillin; 62.5 mg clavulanic acid] every 12 hours)
I was wondering if anyone else has been following this, or has been doing what Dr. Spangler has recommended which is 875mg BID.
Thank you guys again! Great job as always

Mizuho M., DO -

Hi Susan!
Great question. In the segment we said:
Treatment for outpatient uncomplicated diverticulitis:
○ Amoxicillin-clavulanate 1 tablet (875 mg amoxicillin; 125 mg clavulanic acid) every 12 hours
Or
○ Ciprofloxacin (500 mg every 12 hours) plus metronidazole (500 mg every 8 hours)

Truth is guidelines after reviewing all Societies recommendations on this, the evidence across the board is generally "weak". We looked at American Gastroenterological Association; IDSA and I pulled up the 3 referenced articles that Up-to-date references that you were mentioning.
The strongest and most reliable source is likely IDSA who states:
"For adults recovering from intra-abdominal infection, completion of the antimicrobial course with oral forms of moxifloxacin, ciprofloxacin plus metronidazole, levofloxacin plus metronidazole, an oral cephalosporin with metronidazole, or amoxicillin-clavulanic acid (B-II) is acceptable in patients able to tolerate an oral diet and in patients in whom susceptibility studies do not demonstrate resistance (B-II)."

However they don't specify the timing of Rxs (BID vs TID). Neither does AGA. When you actually look at references on up-to-date (PMID23732265/ PMID20526718/ PMID27701164) , none of them are head-to-head randomized controlled trials comparing Amox/Clav Acid Q8 vs. Q12, rather they are comparing treatment vs. not. The 2nd paper (PMID
20526718) is a study that used Amox/Clav Q8 hrs, which is why U-T-D suggests this. However there is NOT strong evidence anywhere to support this.

Sometimes even blanketed recommendations need to be scrutinized. Bottom line is that likely BID vs TID both work. Given that antibiotic efficacy is questionable anyway, I go with BID in my personal practice.
We discuss this more in depth with Rick Pescatore in Sept UCRAP mailbag...so please keep these questions/comments coming! Great stuff. Hope that helps. ~Mizuho

Victor C. -

is colonoscopy really necessary in all cases of diverticulitis?

Mizuho M., DO -

Yes. After the flare up of course. But it is advised. After the first episode of diverticulitis, its recommended patients obtain a urgent outpatient colonoscopy to look for underlying malignancy. Thanks for your question, and we give you a shout out for this question in Sept UCRAP mailbag! Thanks Victor!

Rachel S. -

Very helpful/applicable segment.

Susan- I have used both cipro/flagyl and also Augmentin. When I have consulted GI in the past, they recommended Augmentin 875mg BID x 10 days (and a dose of IV antibiotic like Unasyn if available). I have been leaning more towards Augmentin lately because of the ease of dosing for the patient and not having to take a fluoroquinolone, unless they are already having frequent diarrhea.

Mizuho M., DO -

Agree Rachel! Thanks for your comments! ~Miz

To join the conversation, you need to subscribe.

Sign up today for full access to all episodes and to join the conversation.

To download files, you need to subscribe.

Sign up today for full access to all episodes.
Difficult patient vs. personality disorder? Full episode audio for MD edition 187:27 min - 88 MB - M4AHippo Urgent Care RAP - May 2019 Written Summary 572 KB - PDF

To earn CME for this chapter, you need to subscribe.

Sign up today for full access to all episodes and earn CME.

0.25 Free AMA PRA Category 1 Credits™ certified by Hippo Education

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate

3.25 AMA PRA Category 1 Credits™ certified by Hippo Education

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate