Antibiosis for diverticulitis
In mild to highly acute diverticulitis of an adult, a broad-spectrum antibiotic or an appropriate combination is usually administered through the vein. Metronidazole + fluoroquinolones of the 2nd or 3rd group, amoxicillin + betalactamase inhibitor or cephalosporins of the 2nd and 3rd group have proven to be effective combinations. The compatibility of the antibioses with other drugs of the patient must be clarified and organ damage of the liver or kidney must be included in the planning of the dosage.
Application example
Metronidazole (Clont®): treatment duration 5-7 days, 1g daily. In case of renal insufficiency, the dose must be adjusted or divided. The drug is not recommended during pregnancy and lactation and in case of known blood formation disorders. Possible side effects include temporary changes in taste, nausea, vomiting, diarrhea, darkening of urine, blood count changes, skin reactions, etc.
Duration of intake
If diverticulitis has been diagnosed and is a severe or complicated course, antibiotic treatment should be started very soon. The currently standardized combination treatment should be taken either as an infusion or in tablet form for a period of 7-10 days. It is also possible to start with an infusion treatment in the hospital under inpatient conditions and then to change the medication to a tablet treatment.
It is important not to interrupt the antibiotic treatment or to stop it early. However, exceptions are side effects caused by the treatment or a complete absence of symptomatic improvement. In some cases, antibiotic treatment can also be shortened to about 5 days. This is especially the case if the course of the disease is uncomplicated and mild, but the diverticulitis cannot be treated in any other way.
What to do if antibiotics do not help?
In some cases, the antibiotics taken may not have the expected improving effect. In this case the treatment should be stopped first. Furthermore, the diagnosis should be checked to see if it really is an inflammation of a diverticulum.
In this context, a colonoscopy should be performed to see whether diverticula are inflamed and if so, how many are affected by the inflammation. If it turns out that the inflammation is very far advanced in the intestinal wall, it should be considered whether the treatment should not be performed surgically. For this purpose, the section of the intestine that is covered with the inflamed diverticula is removed and the remaining ends of the intestine are sutured together again.
However, if the intestinal mucosa is only moderately inflamed, it may be considered to continue with an anti-inflammatory treatment for a few days or even weeks instead of antibiotic treatment. However, caution is required when choosing the right medication, as many anti-inflammatory painkillers lead to diarrhea. Another treatment for diverticulitis that cannot be treated properly by the antibiotic initially taken is a change of antibiotics. Although the known combinations of medications are well-tried preparations, since it is not known which pathogens caused the inflammation, a change of preparation can be helpful.