Uncomplicated diverticulitis: outpatient care without antibiotics

Diverticulitis is inflammation of a colonic diverticulum, most often in the sigmoid colon. CT is the test that confirms it and, importantly, classifies it as uncomplicated (inflammation only) or complicated (abscess, perforation, fistula or obstruction). This woman has uncomplicated disease.

For many years everyone with diverticulitis received antibiotics. Two randomised trials (AVOD and DIABOLO) showed that in immunocompetent, systemically well patients with CT-confirmed uncomplicated diverticulitis, antibiotics did not speed recovery or reduce complications. Australian guidance, including Therapeutic Guidelines (Gastrointestinal) and the Gastroenterological Society of Australia, now recommends symptomatic treatment without antibiotics for this group.

Outpatient care is appropriate because she is well, can take oral fluids, has a normal white cell count and a CRP of only 10, and has no peritonism. Management is simple analgesia (paracetamol; avoid NSAIDs and opioids where possible), a clear fluid or low-residue diet until pain settles, and clear instructions to return if fever, worsening pain or vomiting develop. Review in a few days is sensible.

Antibiotics are still used when the patient is immunosuppressed, has significant comorbidity, is septic, has a high CRP or white cell count, has complicated disease on CT, or fails to improve. Well-controlled diabetes alone does not change this.

After recovery, colonoscopy is offered about 6 to 8 weeks later if the patient has not had a recent one, to exclude an underlying cancer. It is never done during the acute episode because of the perforation risk.