From the Guidelines
Antibiotics are not recommended for uncomplicated diverticulitis.
Rationale
- The American College of Physicians suggests that clinicians initially manage select patients with acute uncomplicated left-sided colonic diverticulitis without antibiotics, as emerging concepts in the pathogenesis of diverticulitis suggest an inflammatory rather than an infectious cause 1.
- Low-certainty evidence shows that there may be no differences in diverticulitis-related complications, quality of life, need for surgery, or long-term recurrence between patients receiving and those not receiving antibiotics 1.
- The World Society of Emergency Surgery also recommends not prescribing antibiotic therapy in immunocompetent patients with uncomplicated acute diverticulitis without signs of systemic inflammation, based on high-quality evidence 1.
- A multicenter randomized trial found that antibiotic treatment for acute uncomplicated diverticulitis neither accelerated recovery nor prevented complications or recurrence 1.
- The use of antibiotics without evidence of important benefit to the patient may incur potential harms, including increased costs and contribution to antibiotic resistance 1.
- Key patient characteristics for whom antibiotics may not be necessary include immunocompetent patients with uncomplicated left-sided colonic diverticulitis, with no systemic inflammatory response or immunosuppression, who are not medically frail, do not require hospitalization, and can follow up as an outpatient under medical supervision with social and family support 1.
From the Research
Antibiotic Use in Uncomplicated Diverticulitis
- The use of antibiotics in uncomplicated diverticulitis has been a topic of debate, with some studies suggesting that they may not be necessary 2, 3, 4, 5, 6.
- A systematic review and meta-analysis published in 2019 found that patients with uncomplicated diverticulitis can be monitored off antibiotics, with no significant difference in outcomes between those who received antibiotics and those who did not 2.
- Another study published in 2018 found that current evidence does not support the administration of antibiotics to improve outcomes in carefully selected healthy patients with acute uncomplicated left-sided diverticulitis 3.
- A review of current trends in the treatment of acute uncomplicated diverticulitis published in 2024 found that several quality studies have found similar outcomes in cases of acute uncomplicated diverticulitis treated with or without antibiotics, leading to societal guidelines recommending against the routine use of antibiotics in acute uncomplicated diverticulitis 4.
- A systematic review and meta-analysis published in 2023 found that there is no statistically significant difference in outcomes between patients with acute uncomplicated diverticulitis who were put on observational therapy compared to the antibiotics regime 5.
- A Cochrane review published in 2022 found that the evidence on antibiotic treatment for uncomplicated acute diverticulitis suggests that the effect of antibiotics is uncertain for complications, emergency surgery, recurrence, elective colonic resections, and long-term complications, with low-quality evidence and a need for more trials to obtain more precise effect estimates 6.
Key Findings
- No significant difference in outcomes between patients with uncomplicated diverticulitis who received antibiotics and those who did not 2, 5.
- Current evidence does not support the routine use of antibiotics in acute uncomplicated diverticulitis 3, 4.
- Observational therapy may be an equally safe and effective therapy as compared to antibiotics therapy 5.
- The quality of the evidence is low, and more trials are needed to obtain more precise effect estimates 6.