Acute uncomplicated diverticulitis: antibiotics or not?

Date First Published:
June 17, 2009
Last Updated:
June 17, 2009
Report by:
Griet MZS Spiessens, Emergency Medicine Resident (Reinier de Graaf Groep Delft)
Search checked by:
Griet MZS Spiessens, Reinier de Graaf Groep Delft
Three-Part Question:
In [adult patients, presenting with an episode of acute uncomplicated diverticulitis], does [treatment with antibiotics] have a positive effect on [healing time and prevention of complications], in comparison to [treatment without antibiotics]?
Clinical Scenario:
You are a resident at the Emergency Department of a hospital in the Netherlands, when a 53 year old male presents with acute abdominal pain, diarrhea and a mild fever. He has a history of diverticulitis. After thorough evaluation of your patient, including labs and abdominal CT scan, you want to discharge him with the diagnosis 'acute, uncomplicated diverticulitis, since there was no evidence for an intra-abdominal abcess or bowel perforation. You are about to reassure your patient and give him some supportive therapy, when your supervisor, an Emergency Physician trained in the USA, suggest that you give the man a prescription for oral antibiotics. You wonder if there is any evidence for this treatment...
Search Strategy:
Pubmed,Cochrane, BestBet, Embase, Google
Search Details:
Pubmed:t
Search Term: [diverticulitis] OR/AND [antibiotics] OR [acute diverticulitis]
LIMITS: Human/ All Adult/ Clinical Trial/ RCT
MesH Term: [diverticulitis] AND [antibacterial treatment]
Cochrane:
Search term [diverticulitis]
BestBet: Search Term [diverticulitis]
Embase: Search Term [diverticulitis]
Google: [diverticulitis] and [antibiotica] OR [antibiotics]

Further search through screening of 'related articles
Outcome:
After reading of the abstracts and excluding 1 article in Swedish: 6 articles left
After reading of the articles: 2 relevant articles
Relevant Paper(s):
Study Title Patient Group Study type (level of evidence) Outcomes Key results Study Weaknesses
Conservative treatment of acute colonic diverticulitis: Are antibiotics always mandatory? Hjern F., Josephson T., Altman D., et al Jan-07 Sweden 311 patients with acute diverticulitis and intially conservative treatment Retrospective audit Time to symptomatic recovery No significant difference Observational study
No randomization
Duration of hospital Stay No significant difference
Failed treatment No significant difference
Further events during follow up No significant difference
Is er een rol voor antibiotica bij de conservatieve behandeling van acute diverticulitis coli? (=Is there a role for antibiotics in the conservative treatment of acute diverticulitis coli?) Van de Linde M., Wikkeling M., Driessen W. , et al Dec-96 The Netherlands 52 patients admitted with acute diverticulitis between 1990 and 1993
 Retrospective study Abcedation for which cons treatment 2 patients in AB- group to 4 patients in AB+ group Article in Dutch
Not indexed in Pubmed
Observational
Limited patient group number
Not randomized
No statistic analysis
Surgical intervention 5 patients in AB- group to 11 in AB+ group
Author Commentary:
There is no current evidence that treatment with antibiotics would improve outcome and
decrease complications in adult patients with an episode of acute uncomplicated diverticulitis.
Level of Recommendation: B
Bottom Line:
Do not give antibiotics to adult patients with an episode of acute uncomplicated diverticulitis. There is
no evidence for it and could even lead to complications.
References:
  1. Hjern F., Josephson T., Altman D., et al. Conservative treatment of acute colonic diverticulitis: Are antibiotics always mandatory?
  2. Van de Linde M., Wikkeling M., Driessen W. , et al. Is er een rol voor antibiotica bij de conservatieve behandeling van acute diverticulitis coli? (=Is there a role for antibiotics in the conservative treatment of acute diverticulitis coli?)