Initial resuscitation of patients with acute diverticulitis should focus on determining the severity of the illness, eliminating other causes of symptoms, and appropriate fluid and electrolyte resuscitation (Iable77-4). In patients who demonstrate signs of toxicity such as fever, tachycardia, leukocytosis and severe abdominal pain, intravenous antibiotics are administered. These should include an aminoglycoside (gentamicin or tobramycin 1.5 mg/kg) and either clindamycin 300 to 600 mg or metronidazole 500 mg. licarcillin-clavulanic acid or imipenem have been used as alternative agents. Ihe patient is placed on bowel rest, but in this case, nothing by mouth is given and intravenous fluids are administered. Nasogastric suction is necessary only if the patient manifests signs of bowel obstruction or an adynamic ileus.
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