Outpatient treatment of patients with uncomplicated acute diverticulitis

Evidence supporting outpatient treatment with oral antibiotics in patients with uncomplicated diverticulitis is limited. Our aim was to evaluate the safety and efficacy of an ambulatory treatment protocol in patients with uncomplicated acute diverticulitis.

All patients diagnosed with uncomplicated diverticulitis based on abdominal computed tomography findings from June 2003 to December 2008 were considered for outpatient treatment. Admission was indicated in patients not able to tolerate oral intake and those with comorbidity or without adequate family support. Treatment consisted of oral antibiotics for 7 days (amoxicillin-clavulanic or ciprofloxacin plus metronidazole in patients with penicillin allergy). Patients were seen again at between 4 and 7 days after starting treatment to confirm symptom improvement.

Ninety-six patients were diagnosed with uncomplicated acute diverticulitis and 26 presented at least one criterion for admission. Ambulatory treatment was initiated in 70 (73%) patients. Only two (3%) required admission because of persisting abdominal pain and vomiting, respectively. Intravenous antibiotics resolved the inflammatory process in both cases. In the remaining 68 (97%), ambulatory treatment was completed without complication.

Ambulatory treatment of uncomplicated acute diverticulitis is safe, effective and applicable to most patients with tolerance to oral intake and without severe comorbidity and having appropriate family support.