Antibiotics for diverticulitis

For conservative therapy, antibiotics are used in addition to a strict diet and pain-relieving medication. These are intended to kill the germs responsible for the inflammation. Since the exact germs cannot usually be determined, broad-spectrum antibiotics are used.

These are antibiotics which are effective against many different germs. However, they have to meet certain requirements, since a special germ spectrum can be found in the intestine. Thus the therapy must always be effective against anaerobes as well as against gram-negative bacteria.

This requires a certain combination of different antibiotics. Metronidazole and a fluoroquinolone (e.g. ciprofloxacin) are commonly used. Metronidazole (Clont®) is only effective against Gram-negative anaerobes, the fluoroquinolones are effective against Gram-negative aerobes.

This covers a broad spectrum of possible pathogens. However, since it does not kill all germs, this combination is only used in the mild form of diverticulitis. Another possibility is amoxicillin with clavulanic acid or ampicillin with sulbactam.

These are each combinations of a penicillin with a betalactamase inhibitor. This combination is effective against aerobes and anaerobes and is used for moderately severe diverticulitis, stage 2a or 2b. In the case of stage 2c, i.e. an open perforation in the abdominal cavity, triple combinations of ampicillin, metronidazole and ciprofloxacin are used to detect the largest possible germ spectrum.Imipenem or meropenem are also effective against aerobes and anaerobes and are used as a reserve antibitotic in stage 2c.

They inhibit the cell wall synthesis of the bacteria and are betalactamase-resistant. However, their enteral absorption is very poor. For this reason, these antibiotics can only be administered via the vein.

Nothing should be eaten during the acute inflammation. If necessary, the calorie and nutritional requirements are supplemented via the vein as an infusion (parenteral nutrition). If the symptoms and signs of inflammation improve, a slow diet with tea, with or without sugar, broth or soup and rusks may be taken.

The next step is a liquid diet and white bread. For the next 1-2 weeks, a low-fiber diet should be followed. This includes products made of light flour such as light noodles, white bread, semolina, pudding powder, mashed potatoes, cooked vegetables (no raw vegetables), fruit without peel and seeds.

Low-fat, boiled, steamed as well as dishes prepared on aluminum foil are generally better tolerated during the inflammatory phases. After complete healing of the diverticulitis, a basic diet rich in fiber is advisable. This stimulates the work of the intestine and prevents constipation due to its swelling properties.

Many dietary fibers are contained in fruits and raw vegetables, legumes and cereals. 3-4 portions of fresh fruit, 2 portions of vegetables and 3-4 slices of wholemeal bread or other wholemeal products should be included in the daily diet. Nuts should be well chopped and fruit kernels should not be eaten at all, because in the worst case they can settle into the diverticula and cause inflammation. Since dietary fiber swells, care must be taken to ensure an adequate fluid intake. At least 1.5 – 2 liters should be drunk daily to be able to use the full function of the dietary fibers.