Amoxicillin-clavulanate as good as metronidazole fluoroquinolone combo for Diverticulitis

Outpatient diverticulitis is generally treated with amoxicillin-clavulanate or a combination of metronidazole and a fluoroquinolone (metronidazole-with-fluoroquinolone). The FDA suggested to reserve Fluoroquinolones for conditions with no other alternatives.

This sparked Dr. Charles E Gaber and his team to compare the benefits and short comings of metronidazole-fluoroquinolone and Amoxicillin-Clavulanate combination for outpatient diverticulitis. They published the findings in the June 2021 edition of Annals of Internal Medicine that amoxicillin-clavulanate reduces the risk for fluoroquinolone-related harms without adversely affecting outcomes.

This study was based on claims data on U.S. citizens aged 18 to 64 with private employer-sponsored insurance from 2000 to 2018 and those aged 65 and over with Medicare from 2006 to 2015. Immunocompetent adults were grouped randomly into Metronidazole-with-fluoroquinolone group and amoxicillin-clavulanate group.

Major highlights of the study

• The study evaluated the population for 1-year risks for inpatient admission, urgent surgery, and Clostridioides difficile infection (CDI) and 3-year risk for elective surgery.

• MarketScans and Medicare assisted in identifying new users of the respective drugs. The results showed no statistic difference between the two groups in terms of 1-year risk for admission, urgent surgery and 3-year elective risk for surgery

• Metronidazole with fluoroquinolone population showed a greater 1-year CDI risk than amoxicillin-clavulanate population.

In conclusion the author points out that treatment of diverticulitis with amoxicillin-clavulanate in an outpatient environment can help in minimising the incidence of fluoroquinolone-related side effects without compromising diverticulitis-specific results. Further treatment of outpatient diverticulitis with amoxicillin-clavulanate was shown to be comparably effective as a treatment of metronidazole-with-fluoroquinolone for outpatient diverticulitis.

Source

Gaber CE, Kinlaw AC, Edwards JK, Lund JL, Stürmer T, Peacock Hinton S, Pate V, Bartelt LA, Sandler RS, Peery AF. Comparative Effectiveness and Harms of Antibiotics for Outpatient Diverticulitis : Two Nationwide Cohort Studies. Ann Intern Med. 2021 Jun;174(6):737-746. doi: 10.7326/M20-6315. Epub 2021 Feb 23. PMID: 33617725.