American College of Physicians Endorses No Antibiotics for Most Uncomplicated Acute Diverticulitis
Douglas K. Rex, MD, MASGE, reviewing Qaseem A, et al. Ann Intern Med 2022 Jan 18.
The American College of Physicians (ACP) has issued a clinical guideline regarding acute left-sided diverticulitis. There are 3 recommendations, which were developed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria:
- Use abdominal CT imaging when there is diagnostic uncertainty (conditional recommendation; low-certainty evidence).
- Most patients with acute, uncomplicated, left-sided diverticulitis can be managed in the outpatient setting (conditional recommendation; low-certainty evidence).
- Clinicians can initially manage select patients with acute, uncomplicated, left-sided colonic diverticulitis without antibiotics (conditional recommendation; low-certainty evidence).
In reviewing the evidence, the ACP cited the sensitivity of CT at 94% and specificity at 99%. For uncomplicated diverticulitis (no perforation, abscess, phlegmon, fistula, obstruction, or bleeding), inpatient management did not affect the need for surgery or recurrence. Select patients who do not warrant antibiotics are described as immunocompetent patients without systemic inflammatory response, not medically frail, not requiring hospitalization, able to follow up as an outpatient, and with good social support.
COMMENTIt’s important the ACP developed this guideline because, in my experience, many primary care and emergency department physicians continue to prescribe antibiotics for essentially all cases of acute diverticulitis.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Qaseem A, Etxeandia-Ikobaltzeta I, Lin JS, Fitterman N, Shamliyan T, Wilt TJ; Clinical Guidelines Committee of the American College of Physicians. Diagnosis and management of acute left-sided colonic diverticulitis: a clinical guideline from the American College of Physicians. Ann Intern Med 2022 Jan 18. (Epub ahead of print) (https://doi.org/10.7326/m21-2710)
