Standard regimens for complicated diverticulitis

For empirical therapy of complicated diverticulitis in adults without sepsis or septic shock, as a 3-drug regimen, use:

1gentamicin intravenously; see Gentamicin initial dose calculator for adults for initial dose. See Principles of aminoglycoside use for prescribing considerations and subsequent dosing. See advice on modification and duration of therapy gentamicin gentamicin gentamicin

1tobramycin intravenously; see Tobramycin initial dose calculator for adults for initial dose. See Principles of aminoglycoside use for prescribing considerations and subsequent dosing. See advice on modification and duration of therapy tobramycin tobramycin tobramycin

PLUS with either of the above drugs

metronidazole 500 mg intravenously, 12-hourly. See advice on modification and duration of therapy metronidazole metronidazole metronidazole

PLUS EITHER

1amoxicillin 2 g intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin dosage adjustment. See advice on modification and duration of therapy amoxicillin amoxicillin amoxicillin

1ampicillin 2 g intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see ampicillin dosage adjustment. See advice on modification and duration of therapy. ampicillin ampicillin ampicillin

To avoid the need to switch between intravenous antibiotics at 72 hours, a non-aminoglycoside–containing regimen may be used if it is suspected that intravenous therapy will continue for at least 72 hours. If the likely duration of intravenous therapy is not known, start with the aminoglycoside-containing regimen; do not delay antibiotic administration to make this determination. Non-aminoglycoside–containing regimens are also used if gentamicin or tobramycin is contraindicated. For empirical therapy of complicated diverticulitis in patients without sepsis or septic shock, use:

1ceftriaxone 2 g intravenously, daily. See advice on modification and duration of therapy ceftriaxone ceftriaxone ceftriaxone

PLUS

metronidazole 500 mg intravenously, 12-hourly. See advice on modification and duration of therapy metronidazole metronidazole metronidazole

OR as a single drug

1piperacillin+tazobactam 4+0.5 g (child: 100+12.5 mg/kg up to 4+0.5 g) intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see piperacillin+tazobactam dosage adjustment. See advice on modification and duration of therapy. piperacillin + tazobactam piperacillin+tazobactam piperacillin+tazobactam