amoxicillin-potassium-clavulanate-combination and Diverticulitis

The science of antibiotic therapy for infectious diseases continues to evolve. In many instances where empiric coverage is necessary, treatment with more than one agent is considered prudent. If an etiology is identified, antibiotics are modified based on culture and susceptibility data. Even when the organism is known, more than one antibiotic may be needed. Decisions about antibiotics should be made after assessments of pertinent clinical information, laboratory and microbiology information, ease of administration, patient compliance, potential adverse effects, cost, and available evidence supporting various treatment options. Clinicians also need to consider synergy and local resistance patterns in selecting therapeutic options. In this article, the authors outline monotherapy and combination therapy options for several common infectious diseases.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; Cellulitis; Cephalosporins; Ciprofloxacin; Diverticulitis; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Humans; Meningitis, Bacterial; Neutropenia; Osteomyelitis; Pneumonia; Staphylococcus aureus; Viridans Streptococci

Evidence supporting outpatient treatment with oral antibiotics in patients with uncomplicated diverticulitis is limited. Our aim was to evaluate the safety and efficacy of an ambulatory treatment protocol in patients with uncomplicated acute diverticulitis.. All patients diagnosed with uncomplicated diverticulitis based on abdominal computed tomography findings from June 2003 to December 2008 were considered for outpatient treatment. Admission was indicated in patients not able to tolerate oral intake and those with comorbidity or without adequate family support. Treatment consisted of oral antibiotics for 7 days (amoxicillin-clavulanic or ciprofloxacin plus metronidazole in patients with penicillin allergy). Patients were seen again at between 4 and 7 days after starting treatment to confirm symptom improvement.. Ninety-six patients were diagnosed with uncomplicated acute diverticulitis and 26 presented at least one criterion for admission. Ambulatory treatment was initiated in 70 (73%) patients. Only two (3%) required admission because of persisting abdominal pain and vomiting, respectively. Intravenous antibiotics resolved the inflammatory process in both cases. In the remaining 68 (97%), ambulatory treatment was completed without complication.. Ambulatory treatment of uncomplicated acute diverticulitis is safe, effective and applicable to most patients with tolerance to oral intake and without severe comorbidity and having appropriate family support.

Topics: Acute Disease; Administration, Oral; Adult; Aged; Aged, 80 and over; Ambulatory Care; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Ciprofloxacin; Diverticulitis; Drug Therapy, Combination; Female; Humans; Male; Metronidazole; Middle Aged; Prospective Studies; Treatment Outcome

Outpatient diverticulitis is commonly treated with either a combination of metronidazole and a fluoroquinolone (metronidazole-with-fluoroquinolone) or amoxicillin-clavulanate alone. The U.S. Food and Drug Administration advised that fluoroquinolones be reserved for conditions with no alternative treatment options. The comparative effectiveness of metronidazole-with-fluoroquinolone versus amoxicillin-clavulanate for diverticulitis is uncertain.. To determine the effectiveness and harms of metronidazole-with-fluoroquinolone versus amoxicillin-clavulanate for outpatient diverticulitis.. Active-comparator, new-user, retrospective cohort studies.. Nationwide population-based claims data on U.S. residents aged 18 to 64 years with private employer-sponsored insurance (2000 to 2018) or those aged 65 years or older with Medicare (2006 to 2015).. Immunocompetent adults with diverticulitis in the outpatient setting.. Metronidazole-with-fluoroquinolone or amoxicillin-clavulanate.. 1-year risks for inpatient admission, urgent surgery, and. In MarketScan (IBM Watson Health), new users of metronidazole-with-fluoroquinolone (. Residual confounding is possible, and not all harms associated with these antibiotics, most notably drug-induced liver injury, could be assessed.. Treating diverticulitis in the outpatient setting with amoxicillin-clavulanate may reduce the risk for fluoroquinolone-related harms without adversely affecting diverticulitis-specific outcomes.. National Institutes of Health.

Topics: Adolescent; Adult; Ambulatory Care; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Clostridium Infections; Comparative Effectiveness Research; Cost of Illness; Diverticulitis; Female; Fluoroquinolones; Hospitalization; Humans; Male; Metronidazole; Middle Aged; Retrospective Studies; Risk Factors; Young Adult

Duodenal diverticula are a rare, usually asymptomatic clinical condition. When a complication arises clinical suspicion is key for the diagnosis. On occasion these patients receive a delayed diagnosis and undergo inadequate medical therapy. We report the case of a patient with evidence of duodenal diverticulitis in association with gallbladder inflammation by contiguity, as well as his diagnosis and management.

Topics: Abdomen, Acute; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; beta-Lactamase Inhibitors; Diverticulitis; Duodenal Diseases; Humans; Male

The aim of this study was to evaluate the applicability, safety and efficacy of an ambulatory treatment protocol in patients with uncomplicated acute diverticulitis.. All patients diagnosed with uncomplicated acute diverticulitis based on abdominal computed tomography findings during a 2-year period were prospectively included. Patients with vomiting, severe comorbidities, or without an appropriate family environment were excluded. Ambulatory treatment consisted of oral antibiotics for 1 week (amoxicillin-clavulanic 1 g t.i.d. or ciprofloxacin 500 mg b.i.d. plus metronidazole 500 mg t.i.d. in patients with penicillin allergy). A clear liquid diet for the first 2 days and pain control with oral acetaminophen 1 g t.i.d. were also recommended.. Fifty-three patients were diagnosed with uncomplicated acute diverticulitis and 13 patients were excluded. Therefore, ambulatory treatment was initiated in 40 patients. Only two patients (5%) required admission after outpatient therapy was started due to vomiting and persistent abdominal pain, respectively. In both patients, the inflammatory process was successfully resolved by intravenous antibiotic treatment. In the remaining 38 patients (95%), ambulatory treatment was completed without complications.. Ambulatory treatment of uncomplicated acute diverticulitis is safe, effective and applicable in most patients with tolerance to oral intake and with an appropriate family environment.

Topics: Acute Disease; Administration, Oral; Adult; Aged; Aged, 80 and over; Ambulatory Care; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Ciprofloxacin; Data Interpretation, Statistical; Diverticulitis; Female; Follow-Up Studies; Humans; Male; Metronidazole; Middle Aged; Patient Selection; Prospective Studies; Radiography, Abdominal; Safety; Time Factors; Tomography, X-Ray Computed

The authors report a case of small bowel diverticulitis diagnosed by computed tomography. They describe the CT findings and review its advantages for diagnosis of this uncommon entity that is rarely suspected at physical examination.

Topics: Abdominal Pain; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Constipation; Diverticulitis; Drug Therapy, Combination; Fever; Humans; Jejunal Diseases; Male; Physical Examination; Sensitivity and Specificity; Tomography, X-Ray Computed