Outpatient treatment consists of bowel rest and broad-spectrum oral antibiotic therapy. Patients are instructed to limit activity and to maintain a liquid diet for 48 h. If symptoms improve, low-residue foods are added to the diet. Broad-spectrum antibiotics covering both aerobic and anaerobic bacteria are given. Predominant colonic aerobes include Escherichia coli, Klebsiella and Enterobacter, while Bacteriodes fragilis, Peptostreptococcus, and Clostridium are the predominant colonic anaerobes. Common oral antibiotic agents effective against aerobic organisms include ampicillin (500 mg q 6 h), trimethoprim-sulfamethoxasole (2 tablets q 12 h), ciprofloxacin (500 mg q 12 h), or a cephalosporin, such as cefalexin (500 mg q 6 h). One of these agents is taken in combination with metronidazole (Flagyl 500 mg q 8 h), or clindamycin (Cleocin 300 mg q 6 h), which are utilized to treat the anaerobic organisms. Patients are instructed to contact their physician if increasing abdominal pain, fever, or malaise occur. Once the patient has improved, elective evaluation with contrast barium is performed.
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