It's Actually a Little Complicated: Antibiotics for Uncomplicated Diverticulitis

Abstract

The assumption that acute uncomplicated diverticulitis requires antibiotics has been challenged. In this issue, the Dutch Diverticular Disease Collaborative Study Group report the 2-year follow-up to their trial of observation vs. treatment with amoxicillin-clavulanic acid for acute uncomplicated diverticulitis. The new study provides useful insights on the natural history of acute uncomplicated diverticulitis. The most intriguing data compared rates of elective sigmoid resection between the groups. There was a trend toward more elective surgery in the observation group compared to those in the antibiotic group. It might be too soon to abandon antibiotics for uncomplicated diverticulitis.

Epidemiology, Pathophysiology, and Treatment of Diverticulitis

“…The proportion would increase to 10% if patients who were censored after enrolling in another trial of elective surgery vs conservative management were included in the analysis. 118 Therefore, the long-term safety of withholding antibiotics from patients with uncomplicated diverticulitis is uncertain; larger long-term follow-up studies are needed before well-supported consensus treatment guidelines can be developed. Nonetheless, data indicate that the risk of serious complications after acute uncomplicated diverticulitis is low (4%) whether or not patients receive antibiotics.…”

Long-term follow-up of the AVOD randomized trial of antibiotic avoidance in uncomplicated diverticulitis

“…The DIABOLO trial follow-up reported a higher number of patients undergoing elective sigmoid resection for diverticulitis in the no-antibiotic compared with the antibiotic group (7⋅7 versus 4⋅2 per cent respectively). Although these proportions were not statistically significantly different, criticism was raised suggesting that antibiotic treatment could have a long-term effect in reducing the number of elective sigmoid resections 11 .…”

Management of Diverticulitis

“…A 2-year follow-up of the DIABLO study also demonstrated no difference in complication rate or recurrence, but noted a trend toward an increased rate of elective surgery in the observation group (7.7% in the placebo group, 4.5% in the antibiotic group, P = 0.09) [39•]. This trend became stronger if patients with recurrent disease who were censored due to enrollment in another trial of surgery vs. conservative management were included in the analysis [40].…”