Diverticulitis

Diverticulitis:

  • CT of abdomen and pelvis with contrast
  • Cover bowel (GI) flora (Diverticulitis):
    1. Ciprofloxacin and Flagyl. And/or Zosyn, Levoquin (levofloxacin), or Rocephin 1g IV qd [Levoquin and Flagyl] or Rocephin and Flagyl
      1. Levofloxacin 750mg/D5W 150ml IV qd
      2. Metronidazole (Flagyl) 500mg/NS 100ml IV q6-8hrs
  • Meropenum 1g IV q8hr
    1. Carbapenums: ultra-broad spectrum (Gram POS, Gram NEG, and ANaerobes)
      1. Imipenum: more Gram POS coverage
      2. Meropenum: more Gram NEG coverage (including Pseudomonas, Enterobacteria: E. coli, Klebsiella, Proteus, Serratia)

(ANaerobic pathogens are almost universally susceptible to: Metronidazole (Flagyl), Piperacillin (Zosyn), Ampicillin-sulbactam, Ticarcillin-clavulanic acid, Amoxacillin-clavulanic acid, and Imipenem. Generally are susceptible to Cefoxitin and Clindamycin.)

  • Keep NPO. FOBT.
  • Consult GI (ideally GI that has seen pt before, ex: Dr. Mark Young, Dr. Welch, Dr. Chakradhar M Reddy, MD)
  • Pain control:
    1. Lortab 10 PO q4-6hrs (scheduled)
    2. Morphine 4mg IV q3hr PRN for breakthrough pain.
  • Other:
    1. Protonix 40mg IV qd
    2. MIVF: D5/ ½ NS + KCl 20 mEq IV @ 125ml/hr
    3. Continue supportive care with IV fluids.
    4. Okay for clear liquid diet and advance as tolerated.
    5. Avoid narcotics. [contribute to ileus]
    6. We will start the patient on a probiotic.
    7. Will check a CT abdomen pelvis with IV and oral contrast.

Diverticulitis: (outpatient treatment)

  • The patient will need to be prescribed: Ciprofloxacin 750mg PO bid for 10 days and Metronidazole 500mg PO tid for 10 days.
    • Remember to advise no alcohol while on Metronidazole (Disulfiram-like reaction)
    • Both Ciprofloxacin and Metronidazole (Flagyl) will cause the INR to increase if the patient is taking Warfarin.
      • Adjust Warfarin dose accordingly and check INR regularly.
      • Drugs that increase INR: FAAB5
        • Fluoroquinolone (Ciproflxacin)
        • Azoles (anti-fungals)
        • Amiodarone
        • Bactrim (Trimethoprium-Sulfamethoxizole)
        • Flagyl

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