It’s hard to believe I’ve covered this topic – the evidence for reducing antibiotic exposure in diverticulitis – as long ago as 2013. While it might not be the prudent thing to be the first adopter of a new medical practice, I’d have thought this idea could have had more traction, sooner.
This latest piece of evidence is a “pragmatic” randomized, placebo-controlled, double-blind trial of patients admitted for “non-complicated” diverticulitis. “Non-complicated” in this context means, effectively, non-perforated, and explicitly defined as Hinchey 1a grade. Patients were also excluded if they had multiple systemic inflammatory response criteria, immunosuppression, or other comorbid physical status. Those who received antibiotics were given a regimen including cefuroxime, metronidazole, and amoxicillin/clavulanic acid, while the opposing side received matching placebo.
The trial was rolled out across four hospitals between 2015 and 2019, including three in Auckland, New Zealand, and one in Sydney, Australia and ultimately included 180 participants. The primary outcome was length of hospital stay, the difference for which was not statistically significant at 40 hours for the antibiotic cohort and 46 hours for placebo. The authors tracked many adverse events, discontinuation reasons, and protocol terminations, and there was no clear pattern or apparent trend favoring either cohort, within the scope of the small sample.
After so many years, it would be lovely to finally see better guideline uptake in support of antibiotic stewardship for mild diverticulitis. It certainly seems consistent across all the various trials and cohorts by multiple groups across the world, now, there is minimal, if any, additive benefit – or, at the least, the harms from antibiotic use are similar to those whose diverticulitis progresses left untreated.
“Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial”
https://reader.elsevier.com/reader/sd/pii/S1542356520304262