First 5 minutes and stabilization
›Critical patient workflow
›Continuous monitoring if sepsis physiology
›IV access criteria
›Two large bore IV if hypotension or lactate elevation
›One IV acceptable if stable and outpatient pathway likely
›Fluids
›Balanced crystalloid bolus 10 to 20 mL per kg if hypovolemia
›Reassess after each bolus
›If septic shock then early antibiotics and source control pathway
›Diagnostic plan
›Pregnancy test before CT in reproductive age when relevant
›CT abdomen pelvis if first episode or complication concern
›Surgical consult if peritonitis or free air
Analgesia and symptom control
›Symptom control
›Acetaminophen 1000 mg PO every 6 hours as needed
›Maximum 4000 mg per day
›Lower maximum in liver disease
›Ibuprofen 400 mg PO every 6 to 8 hours as needed
›Avoid in CKD
›Avoid in active GI bleeding
›Hydromorphone 0.5 mg IV every 10 to 15 minutes as needed for severe pain
›Monitor respiratory status
›Transition to PO when stable
›Ondansetron 4 mg IV or PO every 8 hours as needed
›QT prolongation caution
Antibiotics and source control
›Antibiotic strategy aligned to severity and host factors
›Uncomplicated and immunocompetent mild disease
›No antibiotics option with reliable follow up
›Close reassessment within 48 to 72 hours
›Antibiotics advised when higher risk features present
›Comorbidities or frailty
›Refractory symptoms or vomiting
›CRP greater than 140 mg per L
›WBC greater than 15 x 10^9 per L
›CT fluid collection
›Complicated diverticulitis
›Outpatient antibiotic examples local protocol dependent
›Amoxicillin clavulanate 875 mg and 125 mg PO twice daily for 4 to 7 days
›Co amoxiclav 500 mg and 125 mg PO three times daily for 5 days
›If penicillin allergy then alternative regimen per local protocol
›Inpatient antibiotic examples local protocol dependent
›Ceftriaxone 2 g IV daily plus metronidazole 500 mg IV every 8 hours
›Piperacillin tazobactam 4.5 g IV every 6 hours
›Abscess management
›Percutaneous drainage pathway for larger abscesses
›Surgery if generalized peritonitis or failure of non operative management
Nutrition and bowel regimen
›Diet plan by severity
›Clear liquids for 24 to 48 hours if nausea prominent
›Advance diet as pain improves
›Avoid routine bowel rest in stable mild disease
›Reassessment schedule
›Repeat vitals after analgesia and fluids
›Repeat abdominal exam within 60 to 90 minutes
›Escalate to CT or consult if worsening pain or new peritonitis