Treatment: Diverticular Disease PAIN: High-fiber diet, psyllium extract (e.g., Metamucil 1 tbsp PO qd or bid), anticholinergics (e.g., dicyclomine HCl 10-40 mg PO qid). DIVERTICULITIS: NPO, IV fluids, antibiotics for 7-10 d (e.g., trimethoprim/sulfamethoxazole or ciprofloxacin and metronidazole; add ampicillin to cover enterococci in nonresponders); for ambulatory pts, ampicillin/clavulanate (clear liquid diet); surgical resection in refractory or frequently recurrent cases, young persons ( age 50), immunosuppressed pts, or when there is inability to exclude cancer. Pts who have had at least two documented episodes and those who respond slowly to medical therapy should be offered surgical options to achieve removal of the diseased colonic segment, controlling sepsis, eliminating obstructions or fistulas, and restoring intestinal continuity. |