Management of diverticulitis in primary care

Management of diverticulitis in primary care includes:

• Offering an oral antibiotic if the person with acute diverticulitis is systemically unwell, such as co-amoxiclav 500/125 mg three times daily for 5 days, or alternatives like cefalexin plus metronidazole, or trimethoprim plus metronidazole, especially if the person is over 18 years old, aged over 65, dehydrated, or has significant comorbidities or immunosuppression ¹.
• For people with acute diverticulitis who are systemically well, consider a no antibiotic strategy and offer simple analgesia like paracetamol, advising to avoid NSAIDs and opioids if possible, and to re-present if symptoms persist or worsen ¹.
• Provide verbal and written advice on diet and lifestyle, including maintaining a high-fibre diet for life if tolerated, and avoiding NSAIDs and opioids to reduce perforation risk ¹.
• Reassess if symptoms persist or worsen, and consider referral to secondary care for further assessment, including investigations such as contrast CT scan if inflammatory markers are raised ¹.
• In cases of suspected complicated diverticulitis, such as with signs of abscess, perforation, or sepsis, urgent hospital assessment is recommended, with investigations like full blood count, urea and electrolytes, CRP, and imaging ¹.