No Benefit From Antibiotics for Uncomplicated Diverticulitis
Monika Fischer, MD, reviewing Jaung R, et al. Clin Gastroenterol Hepatol 2020 Mar 30.
A randomized, placebo-controlled, double-blinded trial showed no benefit from antibiotic therapy for the management of uncomplicated acute diverticulitis.
Hospitalized patients (N=180) in New Zealand and Australia were assigned to receive antibiotics (n=85) or placebo (n=95) for 7 days for uncomplicated acute diverticulitis (Hinchey 1a grade, established by CT). There was no significant difference in median time of hospital stay between the antibiotic group (40 hours; 95% confidence interval [CI], 24.4–57.6 hours) and the placebo group (45.8 hours; 95% CI, 26.5–60.2 hours) (P=.2). There were no significant differences between groups in adverse events (12% for both groups; P=1.0), readmission to the hospital within 1 week (6% for the placebo group vs 1% for the antibiotic group; P=.1), and readmission to the hospital within 30 days (6% for the placebo group vs 11% for the antibiotic group; P=.3).
COMMENTThis is the third randomized trial proving no benefit from antibiotics for acute uncomplicated diverticulitis. At the same time, there is mounting evidence on antibiotic-induced harm. Still, prescribing antibiotics for diagnosed or suspected diverticulitis is deeply engraved in our minds and often demanded by our patients. It is time to change our practice.
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)
Jaung R, Nisbet S, Gosselink MP, et al. Antibiotics do not reduce length of hospital stay for uncomplicated diverticulitis in a pragmatic double-blind randomized trial. Clin Gastroenterol Hepatol 2020 Mar 30. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2020.03.049)
