A 43 yo M presents with LLQ abd pain, non-bloody diarrhea and subjective fever for 1 d. His vitals are normal, has a WBC of 14 but otherwise normal labs. He is given IV analgesia and clinically has improved, tolerating PO. CT abdomen and pelvis shows diverticulitis without evidence of abscess or perforation. Time to pull out that cipro/flagyl and dispo him, right? Maybe not!
There is no documented evidence to support the use of routine antibiotics in uncomplicated diverticulitis. Recent literature from Europe suggests there is no difference in complication rate, length of hospitalization and recurrence over a 12-month period when treating with or without antibiotics. Future research is needed but given the importance of antibiotic stewardship, pain control and shared decision making may be the future of uncomplicated diverticulitis treatment.
- Chabok A. Pahlman L. Hjern F, Haapaniemi S, Smedh K. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. British J Surg Soc. 2012;99:532-539.
- Korte ND et al. Mild colonic diverticulitis can be treated without antibiotics. A case-control study. Colorectal Disease. 2011;14:325-330.
- Unlu et al. A multicenter randomized clinical trial investigating the cost-effectiveness of treatment strategies with or without antibiotics for uncomplicated acute diverticulitis (DIABOLO trial). BMC Surgery. 2010;10:1-10.