Antibiotics for Acute Uncomplicated Diverticulitis: Time for a Paradigm Change?

Abstract

or years, acute uncomplicated Fdiverticulitis (AUD) has been considered a relatively straightforward disease to treat. Patients typically present to the emergency department or their primary care provider with newonset abdominal pain, often (but not always) in the left lower quadrant. After a presumptive clinical diagnosis ismade, or with a confirmatory computed tomography scan, even a fresh-faced July intern knows that the only real clinical management question is deciding on inpatient or outpatient treatment. If the patient can take liquids, has tolerable pain, and a supportive home environment, we send them home with oral antibiotics. If not, we admit them for intravenous antibiotics, fluids, and pain control. Either way, the prescription of antibiotics have always been a given in the management algorithm, a practice uniformly advocated in practice guidelines, book chapters, and review articles. In this month’s issue of Gastroenterology, the American Gastroenterological Association hasmade things a littlemore complicated for that intern, as well as for the emergency department provider, the primary care provider, and the potential GI consultant. New guidelines for the management of acute diverticulitis suggest that antibiotics be used selectively, rather than routinely, in patients with AUD. The guidelines are accompanied by a detailed technical review. The recommendation itself is based on 2 large multicenter trials. The first,

DOI: 10.1053/j.gastro.2015.10.022

Cite this paper

@article{Peery2015AntibioticsFA, title={Antibiotics for Acute Uncomplicated Diverticulitis: Time for a Paradigm Change?}, author={Anne F. Peery and Neil H. Stollman}, journal={Gastroenterology}, year={2015}, volume={149 7}, pages={1650-1} }