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First-time, Mild Diverticulitis: Antibiotics or Watchful Waiting?

Clinician Reviews. 2019 March;29(3):4e-5e
March 12, 2019 | Clinician Reviews
Bob Marshall, MD, MPH, MISM, FAAFP ; Shailendra Prasad, MBBS, MPH ; Mary Alice Noel, MD ; Jeffrey Burket, MD, FAAFP ; Michael Arnold, DO, FAAFP ; Benjamin Arthur, MD ; Nick Bennett, DO ; Ashley Smith, MD
Author and Disclosure Information

Bob Marshall, Mary Alice Noel, Jeffrey Burket, Michael Arnold, Benjamin Arthur, Nick Bennett, and Ashley Smith are with the Madigan Family Medicine Residency in Gig Harbor, Washington. Shailendra Prasad is in the Department of Family Medicine and Community Health at the University of Minnesota in Minneapolis.

Don’t jump to antibiotics for mild, uncomplicated diverticulitis, a recent clinical trial says. Observation may be just as effective.

WHAT’S NEW

Study looked at true patient-oriented ­outcome

Previous studies of treatment options for acute uncomplicated diverticulitis looked at short-term outcomes, or at readmission, recurrence, and surgical intervention rate or requirement for percutaneous drainage.7,8 This study is the first to look at functional return to work (a true patient-oriented outcome). And it is the only study to follow up at 24 months to gauge long-term outcomes with observational treatment.

 

CAVEATS

Can’t generalize to worse cases

It is worth noting that the findings of this study apply only to the mildest form of CT-proven acute diverticulitis (those patients classified as having Hinchey 1a disease) and are not generalizable to patients with more severe forms. Not enough patients with Hinchey 1b acute diverticulitis were enrolled in the study to reach any conclusions about treatment.

Various guidelines issued outside the United States recommend antibiotics for uncomplicated diverticulitis; however, the American Gastroenterological Association (AGA) indicates that antibiotics should be used selectively.1,9,10 This recommendation was based on an emerging understanding that diverticulitis may be more inflammatory than infectious in nature. The AGA guideline authors acknowledge that their conclusion was based on low-quality evidence.9

CHALLENGES TO IMPLEMENTATION

None to speak of

We see no challenges to implementing this recommendation.

ACKNOWLEDGEMENT

The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center For Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Research Resources or the National Institutes of Health.

Copyright © 2018. The Family Physicians Inquiries Network. All rights reserved.

Reprinted with permission from the Family Physicians Inquiries Network and The Journal of Family Practice (2018;67[7]:435-436,438).

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