Antibiotics / antibiosis for diverticulitis

Antibiosis for diverticulitis

For mild to very acute diverticulitis in an adult, a broad spectrum antibiotic or a corresponding combination is usually given via the vein.
Metronidazole + fluoroquinolones of the 2nd or 3rd group, amoxicillin + beta-lactamase inhibitor or cephalosporins of the 2nd and 3rd group have proven to be effective combinations.

The compatibility of the antibiosis with other drugs of the patient must be clarified and organ damage to the liver or kidney must be included in the planning of the dosage.

Application example

Metronidazole (Clont®): Duration of treatment 5-7 days, 1g daily. At a Renal failure the dose must be adjusted or divided.
During the pregnancy and breastfeeding, as well as with known blood formation disorders, the drug is not recommended.

The side effects are temporary Changes in taste, nausea, Vomit, diarrhea, Urine dark in color, Changes in blood count, Skin reactions i.a. possible.

Please also read our article on this Side effects of antibiotics

Duration of intake

If diverticulitis has been diagnosed and it is severe or complicated, it should be very started antibiotic treatment promptly become. The combination treatment standardized today should either be called Infusion or in tablet form for a period for 7-10 days be taken.

It is also possible to begin with an infusion treatment in the hospital under inpatient conditions and then switch the medication to tablet treatment. It is important that Do not interrupt antibiotic treatment or to end early. However, side effects caused by the treatment or a complete lack of symptomatic improvement are an exception.

In some cases, a antibiotic treatment can be shortened to about 5 days. This is especially the case if the course is uncomplicated, but the diverticulitis cannot be treated in any other way.

What to do if antibiotics don't help

In some cases, the antibiotics you are taking may not have the expected benefit. In this case the Treatment ended initially become. Furthermore, the Diagnostics are checkedwhether it really is an inflammation of a diverticulum at all. In this context a Colonoscopy where you can see if diverticula are inflamed and if so, how many are affected by the inflammation.

Turns out that the Inflammation very advanced in the intestinal wall it should be considered whether the treatment should not be performed surgically. For this, the Intestinal sectionwhich is covered with the inflamed diverticula, removed and the remaining ends of the intestine sewn back together.

The The intestinal mucosa is only moderately inflamed can be considered, instead of antibiotic treatment as well anti-inflammatory treatment for a few days to even weeks perform. However, caution should be exercised when choosing the right medication, as many anti-inflammatory pain relievers cause diarrhea.

Another treatment for diverticulitis that cannot be properly treated by the antibiotic initially taken is a Change of antibiotics. The known drug combinations are well-tried preparations, but since you do not know which pathogens caused the inflammation, a preparation change can be helpful.

Important to know:

Ciprofloxacin (fluoroquinolone of the 2nd group): Due to the breakdown of the drug, the effect of caffeine is increased. Especially patients with cardiac arrhythmias or seizures should avoid caffeine during therapy with ciprofloxacin. In addition, the antibiotic must not be taken with milk, dairy products or antacids (for heartburn), as this weakens the effect.

Ciprofloxacin should also not be used during pregnancy and breastfeeding.

Fluoroquinolones are often associated with accident-free tendon ruptures. Therefore, a weakening of the tendon structure from the intake of fluoroquinolones is to be assumed.

If you have a known intolerance to penicillin, you should urgently refrain from taking amoxicillin and cephalosporins. In this case, the combination of metronidazole + fluoroquinolones is a suitable substitute.

In contrast to metronidazole, amoxicillin and cephalosporins can also be used during pregnancy. Since the combination with a beta-lactamase inhibitor is critical in pregnant women, therapy with cephalosporins would most likely come into consideration for such a patient with a diverticulitis attack.
Read more about the topic here: Antibiotics in Pregnancy

It is therefore crucial to know which patient with which pre-existing conditions and concomitant medication needs the antibiotic in order to make the right choice.

Diarrhea on antibiotic therapy

As a rule, the often used antibiotic drugs are well tolerated. Nevertheless it can high dose antibiotics have some side effects. Here would be above all stomach pain and or Diarrhea to mention, which can often occur with prolonged antibiotic administration. The reason is because the antibiotic ingested acts systemically, i.e. also important intestinal bacteriathat are necessary for digestion, are killed.

The result can be mild to severe diarrhea. To step severe diarrhea on, should be a End of treatment covered become.There are also some steps you can take to prevent or stop diarrhea from occurring. Medication such as loperamide should be avoided. However show naturally oriented preparations, like Omniflora or Perenterol® very good effects. One can use these preparations either take as a precaution before starting antibiotic treatment, or only when the first diarrhea has set in.

Staging

In terms of its severity, colon diverticulitis can be divided into different stages. According to the staging, there are therapeutic consequences for the patient. The Hansen and Stock classification has proven itself in everyday clinical practice. For this, the results of the physical examination, the colonic contrast enema or the computed tomography and the colonoscopy are considered together.

• "Stage 0" represents the complication-free diverticulosis. The diverticula can be detected by means of imaging, but the patient has no symptoms.

• In "Stage I" one speaks of acute diverticulitis, although this is uncomplicated compared to "Stage II". The patient complains of pain in the lower abdomen and may develop elevated temperatures.

• "Stage II" is subdivided from a-c, increasing according to the severity of the complication. In stage IIa, a hardening of the lower abdomen can be felt, the patient feels pressure pain, develops a local immune system and may have a fever. Intestinal paralysis, irritation of the peritoneum and fever can be detected in stage IIb (abscess formation, covered perforation). In stage IIc there is a free intestinal breakthrough, which leads to the acute abdomen.

• In "Stage III", the patient has already had several attacks and further attacks can be expected if the symptoms are continuous.

Stage 0 is not treated, stage I is usually treated conservatively. Stages IIa and b should be operated on as soon as possible. Stage IIc is an emergency and must be operated on immediately. Stage III can be operated on after the second attack at the earliest in an inflammation-free state.

Learn more about the Stages of diverticulitis.

Summary

Diverticulitis is one inflammatory changes in one or more pouches in the bowel area (Diverticulum). Most of the time, diverticulitis is based on lancing and drawing pains in the area of ​​the left upper abdomen noticeable. The main treatment is that Administration of antibiotics or a wait-and-see observation. With a so-called uncomplicated diverticulitiswhere the person concerned has no further risk factors first of all waited and further progress can be viewed.

At severe discomfort and also at complicated processes should be with a timely antibiotic treatment to be started. Although studies have not shown that the administration of several combined antibiotics has an advantage over antibiotics given individually, the combination principle has become established in practice and clinic and is used.

The following antibiotic drugs are given to patients with diverticulitis as an infusion or combined as a tablet: Ciprofloxacin + metronidazole or Piperacillin + tazobactam or ceftriaxone. It is also possible to start with an infusion treatment and then switch to treatment with tablets. Furthermore should Light food for the period of discomfort retained and on a sufficient amount of water to drink be respected.