Adult Guidelines
Diverticulitis

Diverticulitis

Definitions and Clinical Considerations

  • Uncomplicated: localized to sigmoid colon
  • Complicated: CT-confirmed abscess, fistula, obstruction, perforation, or peritonitis (generally mandates surgical or IR management)
  • Unstable: severe sepsis/septic shock or hospital-acquired infection

High risk (≥ 2 of the following):

  • Age ≥ 70 years
  • Major compromise of cardiovascular, liver, or renal function
  • Immunosuppression

Severe (≥ 1 of the following):

  • Severe sepsis or septic shock
  • Diffuse and generalized peritonitis

Hospital-acquired/healthcare-associated (≥ 1 of the following):

  • Infection occurred ≥ 48 hours after admission
  • Infection developing ≥ 48 hours after initial source control
  • Hospitalization ≥ 48 hours in past 90 days WITH receipt of broad-spectrum parenteral antimicrobial therapy

Duration

Uncomplicated: 4-7 days (including all IV and PO doses)

Complicated, source control and initial severe illness: can consider up to 8 days after adequate source control

  • Clinical reassessment should be considered if there is lack of improvement
  • Consider ID consult if no/inadequate source control for step down/duration recommendations

Additional Information

August 1, 2023

  1. Etzioni DA, Mack TM, Beart RW Jr, et al. Diverticulitis in the United States: 1998-2005: changing patterns of disease and treatment. Ann Surg. 2009 Feb;249(2):210-7. PMID: 19212172.
  2. Stollman N, Smalley W, Hirano I, et al. American Gastroenterological Association Institute Guideline on the Management of Acute Diverticulitis. Gastroenterology. 2015 Dec;149(7):1944-9. PMID: 26453777.
  3. Chabok A, Påhlman L, Hjern F, et al. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012 Apr;99(4):532-9. PMID: 22290281. 
  4. Feingold D, Steele SR, Lee S, et al. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum. 2014 Mar;57(3):284-94. PMID: 24509449.
  5. Bohnen JM, Marshall JC, Fry DE, et al. Clinical and scientific importance of source control in abdominal infections: summary of a symposium. Can J Surg. 1999 Apr;42(2):122-6. PMID: 10223073.
  6. Schug-Pass C, Geers P, Hügel O, et al. Prospective randomized trial comparing short-term antibiotic therapy versus standard therapy for acute uncomplicated sigmoid diverticulitis. Int J Colorectal Dis. 2010 Jun;25(6):751-9. PMID: 20140619.
  7. Sawyer RG, Claridge JA, Nathens AB, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015 May 21;372(21):1996-2005. PMID: 25992746.
  8. Montravers P, Tubach F, Lescot T, et al. Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial. Intensive Care Med. 2018 Mar;44(3):300-310.