›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 loop
›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
17Disposition/dispo22
ICU criteria
›ICU triggers
›Septic shock requiring vasopressors
›Lactate 4 mmol per L or higher with clinical instability
›Need for invasive ventilation
Inpatient admission criteria
›Admission indications
›Complicated diverticulitis on CT
›Abscess requiring IV antibiotics or drainage
›Free air or peritonitis
›Inability to tolerate oral intake
›Uncontrolled pain requiring IV opioids
›Immunocompromised state
›Unreliable follow up or unsafe home setting
Observation and outpatient criteria
›Outpatient pathway criteria
›Hemodynamic stability
›No peritonitis
›Oral intake adequate
›Pain controlled with PO meds
›Reliable follow up within 48 to 72 hours
›Clear return precautions understood
›Observation pathway criteria
›Borderline oral tolerance improving with ED therapy
›Diagnostic uncertainty awaiting CT results
18Discharge Instructions/di18
Copy discharge instructions
›Discharge instruction text
›You were treated for suspected or confirmed diverticulitis
›This is inflammation of small pouches in the colon and can cause left sided lower abdominal pain and fever
›Take medications exactly as prescribed
›If antibiotics were prescribed then finish the full course unless told otherwise by your clinician
›Use acetaminophen as directed for pain
›Avoid NSAIDs if you were told you have kidney disease stomach ulcers or bleeding risk
›Drink fluids regularly
›Start with a light diet and advance as pain and nausea improve
›Follow up with your primary care clinician within 2 to 3 days
›Gastroenterology or surgery follow up may be needed based on CT results
›Return to the emergency department now for
›Worsening abdominal pain
›New severe abdominal tenderness
›Persistent vomiting or inability to drink fluids
›Fever not improving
›Dizziness fainting or weakness
›Blood in stool or black stool
19References/r7
Guidelines and high quality sources
›Evidence base for acute diverticulitis management
›American Gastroenterological Association Clinical Practice Update on Medical Management of Colonic Diverticulitis 2021
›World Society of Emergency Surgery WSES guidelines update for acute colonic diverticulitis 2020
›American Society of Colon and Rectal Surgeons Clinical Practice Guidelines Treatment of Left Sided Colonic Diverticulitis 2020
›NICE Diverticular disease antimicrobial prescribing visual summary updated September 2024
›NICE Diverticular disease diagnosis and management NG147 2019
›Project instructions
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.