Background
The prevalence of diverticulosis is between 28–45% in the general population and by more than 60% for those over 70 years old. A further increase in the hospitalization rate due to complications can be observed. Furthermore, younger patients are now also increasingly suffering from diverticulosis. It is time to question the non-critical use of antibiotic treatment as well as the necessity of surgery. New treatment approaches must be found.
Objective
What significance does conservative treatment, especially antibiotic treatment, have in the treatment of diverticular disease?
Methods
The current literature and the first S2k guidelines on “diverticular disease/diverticulitis” were evaluated.
Results
There are several options in the primary prophylaxis of diverticular disease. A high-fiber, low-meat diet, physical activity and weight management as well as avoiding cigarettes can reduce complications. Avoiding non-steroidal anti-inflammatory drugs (NSAID), corticoids and opioids also reduces the risk of complications. As long as there are no risk factors, the use of antibiotics is not normally necessary in the treatment of acute uncomplicated diverticular disease. Aminosalicylates and non-resorbable antibiotics have not been proven to be effective. The treatment of acute complicated diverticulitis consists of antibiotics, infusion of electrolytes and, if necessary abscess drainage or surgery.
Conclusion
The indications and correct selection of conservative treatment has to be determined by evaluation of the stage of diverticular disease, the physical condition and the patient’s risk factors. Antibiotic treatment is ultimately only one part of the conservative management.