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Three Part Question

In [adult patients, presenting with an episode of acute uncomplicated diverticulitis], does [treatment with antibiotics] have a positive effect on [healing time and prevention of complications], in comparison to [treatment without antibiotics]?

Clinical Scenario

You are a resident at the Emergency Department of a hospital in the Netherlands, when a 53 year old male presents with acute abdominal pain, diarrhea and a mild fever. He has a history of diverticulitis. After thorough evaluation of your patient, including labs and abdominal CT scan, you want to discharge him with the diagnosis 'acute, uncomplicated diverticulitis, since there was no evidence for an intra-abdominal abcess or bowel perforation. You are about to reassure your patient and give him some supportive therapy, when your supervisor, an Emergency Physician trained in the USA, suggest that you give the man a prescription for oral antibiotics. You wonder if there is any evidence for this treatment...

Search Strategy

Pubmed,Cochrane, BestBet, Embase, Google
Pubmed:
Search Term: [diverticulitis] OR/AND [antibiotics] OR [acute diverticulitis]
LIMITS: Human/ All Adult/ Clinical Trial/ RCT
MesH Term: [diverticulitis] AND [antibacterial treatment]
Cochrane:
Search term [diverticulitis]
BestBet: Search Term [diverticulitis]
Embase: Search Term [diverticulitis]
Google: [diverticulitis] and [antibiotica] OR [antibiotics]

Further search through screening of 'related articles

Search Outcome

After reading of the abstracts and excluding 1 article in Swedish: 6 articles left
After reading of the articles: 2 relevant articles

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Hjern F., Josephson T., Altman D., et al Jan 2007 Sweden	311 patients with acute diverticulitis and intially conservative treatment	Retrospective audit	Time to symptomatic recovery	No significant difference	Observational study No randomization
			Duration of hospital Stay	No significant difference
			Failed treatment	No significant difference
			Further events during follow up	No significant difference
Van de Linde M., Wikkeling M., Driessen W. , et al Dec 1996 The Netherlands	52 patients admitted with acute diverticulitis between 1990 and 1993	Retrospective study	Abcedation for which cons treatment	2 patients in AB- group to 4 patients in AB+ group	Article in Dutch Not indexed in Pubmed Observational Limited patient group number Not randomized No statistic analysis
			Surgical intervention	5 patients in AB- group to 11 in AB+ group

Comment(s)

There is no current evidence that treatment with antibiotics would improve outcome and decrease complications in adult patients with an episode of acute uncomplicated diverticulitis. Level of Recommendation: B

Clinical Bottom Line

Do not give antibiotics to adult patients with an episode of acute uncomplicated diverticulitis. There is no evidence for it and could even lead to complications.

References

1. Hjern F., Josephson T., Altman D., et al Conservative treatment of acute colonic diverticulitis: Are antibiotics always mandatory? Scandinavian Journal of Gastroenterology 2007;42:41-7
2. Van de Linde M., Wikkeling M., Driessen W. , et al Is er een rol voor antibiotica bij de conservatieve behandeling van acute diverticulitis coli? (=Is there a role for antibiotics in the conservative treatment of acute diverticulitis coli?) Nederlands Tijdschrift voor Heelkunde 1996; 5: 194-197