•Empiric treatment or defined if you have a culture for MSSA and MRSA. Cellulitis-polymicrobial: cover for both Staphylococcus and Streptococcus species
•Oral agents for MSSA: cephalexin, dicloxacillin, doxycycline, clindamycin, or TMP/SMX
•Oral agents for MRSA: doxycycline, clindamycin or TMP/SMX
•IV agents: vancomycin, linezolid, daptomycin, clindamycin, ceftaroline (5th gen ceph), tigecycline, and often in combination with others empirically
•Outpatient uncomplicated diverticulitis: bowel rest, no antibiotics for 2-3 days (new rec). If no improvement or worsen, admit inpatient.
•Inpatient Uncomplicated Diverticulitis +/- microperforation (WITHOUT abscess or large perforation):
•Conservative management: bowel rest (NPO, mIVF), IV abx (ceftriaxone/flagyl, zosyn, cefotetan), monitor pain and labs
•If pain and leukocytosis resolve, transition to oral abx for 10-14 days
•Recommend low fiber diet during treatment then transition to high fiber diet as tolerated to prevent future occurrences. OK to eat seeds!
•Patients need a colonoscopy 6 weeks after symptoms resolve
•Elective colectomy should be offered to patients with recurrent diverticulitis who develop symptoms that can be convincingly attributed to the disease, and to those at a higher risk of developing complications or dying from recurrent attacks
•Old, common rule: 3x in one year
•If failed conservative management, Hartmann's procedure (colostomy and rectal stump)
7th EditionJulie S Snyder, Mariann M Harding 7th EditionGary A. Thibodeau, Kevin T. Patton 7th EditionJulie S Snyder, Linda Lilley, Shelly Collins 5th EditionJeanette Lancaster, Marcia Stanhope