Diverticulitis Antibiotics - What Antibiotics Are Used for Diverticulitis

Brianna Anderson
Brianna Anderson
May 15, 2024
6
min read
Medically reviewed by:
Trager Hintze, PharmD
Diverticulitis Antibiotics - What Antibiotics Are Used for Diverticulitis
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An estimated 33% to 66% of people will develop diverticulitis at some point [1]. This condition may sound scary and debilitating, but don’t worry - Most people can fully recover with the help of diverticulitis antibiotics and simple management strategies. 

The Use of Antibiotics To Treat Diverticulitis 

Diverticulitis develops when the colonic wall weakens and bulges outward, creating sac-like pouches. These pockets can get infected with bacteria and swell. The severity of this colon infection can range from mild to severe. People with severe infections may develop abscesses or colon ruptures [1].

Healthcare providers typically use oral or IV antibiotics to treat diverticulitis. These medications can eliminate harmful bacteria and allow the colon to heal [1].

What antibiotics are used for diverticulitis? Here are a few commonly prescribed medications:

  • Amoxicillin [2] 
  • Augmentin
  • Ciprofloxacin 
  • Doxycycline 
  • Flagyl 

The best antibiotic for diverticulitis varies based on several factors, including drug allergies and the severity of infection. A healthcare provider can determine the right treatment. 

Specific Antibiotics, Uses, and Considerations 

Diverticulitis antibiotics have varying mechanisms and side effects. Understanding the differences between these medications can help you work with your doctor to choose a suitable antibiotic. 

Amoxicillin for Diverticulitis

Amoxicillin is a commonly prescribed bactericidal B-lactam (beta-lactam) antibiotic. This medication eliminates bacteria by preventing them from producing an enzyme that maintains cell wall structures. It kills gram-positive and -negative bacteria, either of which can cause diverticulitis [3].

Is amoxicillin a good antibiotic for diverticulitis? A recent animal study suggests that this medication can effectively treat this disease. The affected rats had less inflammation and decreased bacteria levels in the colon after receiving amoxicillin. They also had improved appetites, digestion, and nutrition absorption [2].

Like all drugs, amoxicillin can cause side effects, such as [3]:

  • Nausea
  • Vomiting
  • Diarrhea
  • Rash 
  • Agitation or anxiety

Augmentin for Diverticulitis

Co-amoxiclav, a combination of amoxicillin and clavulanic acid, is often used to treat diverticulitis due to its effectiveness against a broad range of bacteria, including those that commonly infect the digestive tract.

Augmentin combines amoxicillin with clavulanic acid. The second ingredient prevents bacteria from creating enzymes called beta-lactamases. These enzymes can make the bacteria resistant to amoxicillin and similar antibiotics. Augmentin takes away this resistance so the amoxicillin can kill the bacteria [4].

 A 2021 study recommends using Augmentin for diverticulosis because it has fewer adverse effects than metronidazole with fluoroquinolone [5].

Potential side effects of Augmentin include [4]:

  • Diarrhea or loose stools
  • Nausea
  • Vomiting
  • Abdominal pain 
  • Rash 
  • Higher risk of secondary C. difficile colitis 

Ciprofloxacin for Diverticulitis

Ciprofloxacin is a fluoroquinolone antibiotic that stops bacteria from replicating. It can eliminate gram-negative bacteria, such as E. coli and Salmonella [6].

Cipro has a similar level of effectiveness as Augmentin for diverticulosis. However, patients who receive fluoroquinolone have a higher risk of developing a C. difficile infection within one year of treatment. As a result, the Food and Drug Administration recommends clinicians only use Cipro for diverticulosis after exhausting other, safer treatment options. [5].

Cipro has several possible side effects, such as [6]:

  • Nausea 
  • Diarrhea
  • Prolonged QT interval or irregular heart rhythm
  • Liver damage 
  • Tendon rupture 
  • Photosensitivity 

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Flagyl for Diverticulitis

Healthcare providers often use Flagyl (metronidazole) to treat anaerobic and microaerophilic bacterial infections possibly found in the colon. Flagyl targets these bacteria to reduce inflammation and infection in the affected areas of the colon [7].

Clinicians may prescribe Cipro and Flagyl for diverticulosis. However, they should use this combination as a last resort to minimize the risk of liver injury, peripheral neuropathy, and other side effects caused by Cipro [5].

Common side effects of Flagyl include [6]:

  • Headache 
  • Vaginitis 
  • Nausea
  • Metallic taste in the mouth 
  • Dizziness
  • Abdominal pain 

Patients should also watch for signs of neurological disturbances and bacterial infections, which can occur after prolonged use of Flagyl [7].

Doxycycline for Diverticulitis

Doxycycline is an antibiotic used for treating diverticulitis when other antibiotics are not suitable. It works by inhibiting bacterial protein synthesis, helping to clear the infection.

Doxycycline hyclate is a tetracycline that eliminates many gram-positive and -negative bacteria species. It crosses the cell membranes and halts the bacteria’s growth, killing it. [8] Healthcare providers can use doxycycline for diverticulitis caused by bacterial overgrowth [9].

Doxycycline may cause these common adverse reactions [8]:

  • Diarrhea
  • Vomiting
  • Nausea
  • Photosensitivity
  • Skin irritation or rash
  • Headache
  • Discolored teeth 

Medications To Avoid During Treatment 

Certain medications can raise the risk of gastrointestinal bleeding for people with colon infections. Drugs to avoid with diverticulitis include [10]: 

  • Aspirin
  • Ibuprofen 
  • Naproxen sodium 
Avoid ibuprofen for diverticulitis as it can worsen symptoms and increase the risk of complications like perforation, which is a hole or tear in the inflamed pouches of the colon.

Tylenol is a safer option for pain relief while treating diverticulosis [10]. 

Alternative Treatments and When Antibiotics Aren't Needed

For many individuals with mild diverticulitis, antibiotics may not be necessary. Mild cases can often be managed with simple, non-medication approaches like dietary adjustments, rest, and over-the-counter pain relief [11]. Temporarily following a low-fiber or clear-liquid diet can help the digestive system rest, minimizing irritation in the colon. Once symptoms improve, slowly reintroducing high-fiber foods supports long-term gut health and can reduce the risk of future flare-ups.

Rest is also vital, allowing the body to focus on healing, while gentle pain relief, such as acetaminophen or a heating pad, can help alleviate discomfort. In cases where symptoms worsen or include signs like fever and severe pain, antibiotics may be recommended to prevent further infection. Always consult a healthcare provider to ensure the best approach based on the severity of symptoms and health history.

Catch and Treat Diverticulosis Earlier 

Antibiotics are one of the most effective treatments for diverticulosis. These drugs prevent harmful bacteria from growing in the gut, allowing the colon to heal. A skilled healthcare professional can help you choose the proper antibiotic regimen. 

Monitor for diverticulosis at home with an immunochemical fecal occult blood test kit (IFOBT). This affordable and fast test reveals hidden blood in the stool, which can indicate a gastrointestinal disorder

Order a Colonox IFOBT kit today to start tracking your gut health. 

References

[1] E. Teke, et al., “Management of Acute Uncomplicated Diverticulitis: Inpatient or Outpatient,” Sisli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital, 2022.‌ [Accessed May 6, 2024]. 

[2] M. G. Soliman, H. A. Mansour, W. A. Hassan, and E. Shawky, “Protective effects of amoxicillin and probiotics on colon disorders in an experimental model of acute diverticulitis disease,” Inflammopharmacology, vol. 30, no. 6, pp. 2153–2165, Nov. 2022. [Accessed May 6, 2024]. 

[3] B. J. Akhavan, N.R. Khanna, and P. Vijhani, “Amoxicillin,” StatPearls, 2023. [Accessed May 6, 2024]. 

[4] J. Evans, M. Hanoodi, and M. Wittler, “Amoxicillin Clavulanate,” StatPearls, 2020. [Accessed May 6, 2024].

[5] C. E. Gaber et al., “Comparative Effectiveness and Harms of Antibiotics for Outpatient Diverticulitis Two Nationwide Cohort Studies,” Annals of Internal Medicine, vol. 174, no. 6, pp. 737–746, Jun. 2021. [Accessed May 6, 2024].

[6] T. Thai, P. M. Zito, and B. H. Salisbury, “Ciprofloxacin,” StatPearls, Oct. 2019. [Accessed May 6, 2024].

[7] C. B. Weir and J. K. Le, “Metronidazole,” StatPearls, 2023. [Accessed May 6, 2024].

[8] R. S. Patel and M. Parmar, "Doxycycline Hyclate," StatPearls, 2020. [Accessed May 6, 2024].

[9] M.-L. Dichman, S. J. Rosenstock, and D. M. Shabanzadeh, “Antibiotics for uncomplicated diverticulitis,” Cochrane Database of Systematic Reviews, vol. 2022, no. 6, Jun. 2022. [Accessed May 6, 2024].

[10] Cleveland Clinic Staff, “Diverticulitis,” Cleveland Clinic, Apr. 10, 2023. [Accessed May 6, 2024].

[11] Mayo Clinic, "Diverticulitis: Diagnosis & treatment," Mayo Clinic, 6 Dec. 2022. [Accessed: 28-Oct-2024].

About the Author
Brianna Anderson
About the Reviewer
This blog was
Medically reviewed by:
Trager Hintze, PharmD

Trager Hintze is a clinical assistant professor and emergency medicine clinical pharmacist located in College Station, Texas. He has a bachelor's degree in biology as well as a Doctor of Pharmacy degree. He balances teaching at Texas A&M University College of Pharmacy and practicing emergency medicine at St. Joseph Regional Health Hospital.

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