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Does Diverticulitis Require Antibiotics?

Those with a diverticular disease can occasionally develop a flare-up called diverticulitis. But does diverticulitis require antibiotics?

This recent article by Dr. Jill caught my attention, and I wanted to share it with my patients.

Diverticulitis

The American Gastroenterological Association recommends managing each diverticulitis case uniquely.

No need for everyone to immediately start on oral antibiotics. However, it’s a bit of an art to determine who benefits from a conservative approach versus the immediate use of antibiotics.

https://gastro.org/clinical-guidance/medical-management-of-colonic-diverticulitis/

Conservative Managemment

I manage my patients conservatively by having them switch their diet immediately when they feel a diverticulitis flare-up coming.

I address the decision of antibiotics and diverticulitis if I don’t see improvement with the following steps.

Diet

Most patients benefit from switching to a low-fiber diet. But low fiber doesn’t tell us much, does it? I eat a bowl of fruits daily along with a primarily whole-plant-based diet. For me, a low-fiber diet would be cutting out the bowl of fruits.

My patients know I’m a stickler for data. Track how you feel when you try a particular diet during a flare-up. We make adjustments for the next flare-up and get it dialed in.

Hydration

I prefer hydrating with water, and others prefer to get their hydration through food.

Regardless of your style, you’ll have less water available in your circulation during colon inflammation. Adding a little more will help.

Exercise

I like my patients to walk around and engage in gentle resistance training during a diverticulitis attack.

They are to avoid anything that will exhaust their system or dehydrate them.

Movement improves gut peristalsis and improves enteric blood flow.

Inflammation

Inflammation is a new-age word similar to stress. I get it, some are averse to using it. But it remains a big deal in medicine.

Antibiotics for diverticulitis are effective, primarily because of their anti-inflammatory properties.

If I lower inflammation in my patients, they often respond favorably. As Dr. Jill points out in the article, the initial stages of diverticulitis are an inflammatory process.

With the lining of the diverticular pouch inflamed, it loses its protection against bacteria. That’s how an infection can set in.

Getting Treatment

If these steps fail or high fevers and worsening pain develops, it may be time to treat diverticulitis with oral antibiotics.

If you’re traveling and won’t have access to the proper medications, it’s best to have some antibiotics on hand.

I often aim to treat with a less broad-spectrum medication and only escalate to a double-antibiotic regimen if this fails.

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