Antibiotics vs no antibiotics in the treatment of acute uncomplicated diverticulitis
Diverticula are small outpouchings that can form in the lining of the digestive system (more commonly found in the descending and sigmoid portions of the colon). They form when the inner lining of the intestine bulges or herniates through weak spots in the muscular wall. They are usually asymptotic when they are not inflamed. When diverticula become inflamed, it is known as diverticulitis which can cause abdominal pain, fever, nausea, and changes in bowel habits. Acute diverticulitis has different scales and scores to classify what type of diverticulitis a patient has, but acute uncomplicated diverticulitis (AUD) refers to an acute inflammation of the diverticula of the colon without the presence of any abscesses, perforations, or obstruction.
AUD has generally been treated with intravenous antibiotics (like Augmentin or a fluoroquinolone with Flagyl), bowel rest, IV fluids and pain control. This study asks the question, “Are antibiotics necessary to treat acute uncomplicated diverticulitis, or can conservative management be used to garner the same effects without compromising the patient’s health?” The authors of this study looked through scientific databases including Cochrane Library, MEDLINE, Embase, Science Citation Index Expanded and ClinicalTrials.gov. The outcomes the authors were looking for were whether a patient would experience a complication like a bowel obstruction, colonic perforation or an abscess not being on an antibiotic. Other outcomes included if patients would be readmitted to the hospital, how long the hospital stay was, if the diverticulitis came back and if the patient’s required surgery after the treatment. Eight studies were included in this study with a total of 2,469 patients. 1,626 patients were in the non-antibiotic group, while 843 patients were given antibiotics.
Ultimately, the study found no significant differences between the groups in terms of recurrence rate, readmission rate, need for surgery during follow-up, or the need for percutaneous abscess drainage. However, the non-antibiotic group had a lower mean length of hospital stay compared to the antibiotic group. These findings suggest that a watchful waiting approach, without immediate antibiotic treatment, may be a viable option for managing acute uncomplicated diverticulitis. This approach avoids unnecessary antibiotic use, potentially reducing the risk of antibiotic resistance development and sparing patients from potential side effects associated with antibiotic treatment.
