Inpatient treatment

1. Severe cases require hospitalization for gastrointestinal tract rest (NPO), intravenous fluid hydration, correction of electrolyte abnormalities, and antibiotics. Nasogastric suction is initiated if the patient is vomiting or if there is abdominal distention.

2. Antibiotic coverage should include enteric gram-negative and anaerobic organisms a. Ampicillin 1-2 gm IV q4-6h AND

b. Gentamicin or tobramycin 100-120 mg IV (1.5-2 mg/kg), then 80 mg IV q8h (5 mg/kg/d) AND

c. Metronidazole (Flagyl) 500 mg IV q6-8h (15-30 mg/kg/d).

d. Monotherapy with a second-generation cephalosporin (eg, cefoxitin, cefotetan) or an extended-spectrum penicillins (eg, piperacillin-tazobactam, ampicillin-sulbactam) also may be used.

C. The abdomen should be frequently reassessed for the first 48-72 hours. Improvement should occur over 48-72 hours, with decreased fever, leukocytosis, and abdominal pain. Failure to improve or deterioration are indications for reevaluation and consideration of surgery. Analgesics should be avoided because they may mask acute deterioration, and they may obscure the need for urgent operation.

D. Oral antibiotics should be continued for 1-2 weeks after resolution of the acute attack. Ciprofloxacin, 500 mg PO bid.

E. After the acute attack has resolved, clear liquids should be initiated, followed by a low residue diet for 1-2 weeks, followed by a high-fiber diet with psyllium.

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