Best Evidence Topics
  • Send this BET as an Email
  • Make a Comment on this BET

Acute uncomplicated diverticulitis: antibiotics or not?

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
Search Term: [diverticulitis] OR/AND [antibiotics] OR [acute diverticulitis]
LIMITS: Human/ All Adult/ Clinical Trial/ RCT
MesH Term: [diverticulitis] AND [antibacterial treatment]
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
311 patients with acute diverticulitis and intially conservative treatmentRetrospective auditTime to symptomatic recoveryNo significant differenceObservational study No randomization
Duration of hospital StayNo significant difference
Failed treatmentNo significant difference
Further events during follow upNo 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 studyAbcedation for which cons treatment2 patients in AB- group to 4 patients in AB+ groupArticle in Dutch Not indexed in Pubmed Observational Limited patient group number Not randomized No statistic analysis
Surgical intervention5 patients in AB- group to 11 in AB+ group


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.


  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