#EMconf: Antibiotics Necessary for Uncomplicated Diverticulitis?

Clinical Question: Do antibiotics improve time to recovery or complication rate in uncomplicated diverticulitis?

Take Home Message: In CT-proven uncomplicated diverticulitis antibiotics do not significantly improve time to recovery or prevention of complications such as abscess, fistula, or perforation.

Literature Summary:
Study 1: Chabok (2012)

  • Multi-center unblinded randomized control trial of antibiotics vs supportive care in >600 patients with CT-confirmed diverticulitis¬†
  • No significant difference in 12 month complication rate (abscess, perforation, fistula) with 1.9% complication rate in supportive care group versus 1.0% complication rate in group receiving antibiotics (p=0.30)

Study 2: Daniels (2017)

  • Mutli-center unblinded randomized control trial of antibiotics versus supportive care in >500 patients with first-time CT-confirmed uncomplicated diverticulitis
  • No significant difference in time to recovery with median time to recovery of 14 days in control group and 12 days in group receiving antibiotics (p=0.15)¬†
  • No significant difference in 6 month complication rate with 3.8% in the control group and 2.6% in the antibiotics group experiencing complications (p=0.37)

 

References:
1. Chabok A et al. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. British Journal of Surgery 2012; 99:532-539.
2. Daniels L et al. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated diverticulitis. British Journal of Surgery 2017; 104: 52-61.