Suggest Treatment For Symptoms Of Diverticulitis
Concierge Medicine, Executive Health & Wellness. I'm at Day 7 of diverticulitis bout; six days into a regiment of Metronidazole and Ciprofloxacin. Last three days I've been plagued with, body ache, joint pain, fatigue and general "not-hitting-on-all-cylinders." Thoughts?
Usually takes 14 days to respond please attach reports of stool cuture and antibiotic sensitivity with follow up.
Detailed Answer:
Hello Dear,
Thanks for posting your query on this forum.
I am a Gastroenterologist and would be answering your query.
Have gone through your details and i appreciate your concerns.
First line i would like to say to you is don't worry all the symptoms you have mentioned above are tell tail symptoms of diverticulitis. Pain,Fatigue,Nausea,Malaise,Bodyache,loss of appetite etc are all classical features of diverticulitis.
Large intestine consists of numerouis small microscopic ridges and depresssion termed as diverticulas.Due to contaminated food or constipation etc these diverticulas are occupied by harmful bacterias.These bacterias multiply here and form colonies.Our intestine is lined by layer of mucosa.Toxins released by bacteria's severely damages this mucosa causing inflammation(Diver ti culitis=inflammation of diverticulas).This inflammation causese pain and malaise, as patient can't digest food properly there is severe electrolyte disbalance causing nause,fatigue,spasms etc.
14 days therapy with ciprofloxacin and metronidazole is gold standard treatment of diverticulitis.Most likely ionfection is caused either by a protozoa(metronidazole is for protozoa) or a gram negative bacteria like Escherichia coli(Ciprofloxacin would cover it),But inection will take its time and its just the 7th day.As per standard protocol you would be kept on injectibles for 14days. You should start feeling better by the end of 10th day of therapy.
However a few more medications should be added to current schedule-
Mesalamine-It is clear that inflammation is the main feature of acute diverticulitis.To reuce inflammation it should be given along with antibiotic therapy.
Probiotic should be given daily they help to build up the good intestinal flora.The rationale for the use of probiotics is based on the theory that endogenous intestinal microflora play a crucial role in the pathogenesis of these disorders The use of probiotics will restore the normal intestinal flora that may have been altered in diverticular disease due to stasis and reduced colonic transit time.
A stool culture should be done to see if bacteria is sensitive to the antibiotic you are on.Rifaximin is a poorly absorbed antibiotic and is very effective against Gram-positive and Gram-negative bacteria and has high bioavailability in the gastrointestinal tract.So in case ciprofloxacin is not helping much rifaximin should be tried.
As of now if you feel a betterment of 5 on a scale of 10 then its ok.Just take rest and discuss the above suggestion with your treating doctor.
Hope i explained your query in detail.
In case you need any further advice feel free to follow up.
Warm regards and get well soon.