Antibiotics do not reduce hospital stay in uncomplicated diverticulitis

Researchers from New Zealand and Australia have found in a new study that antibiotics may not be needed in patients hospitalized for uncomplicated acute diverticulitis.

Furthermore Antibiotics may not reduce length of hospital stay for uncomplicated diverticulitis

The results of the study have been published online by Clinical Gastroenterology and Hepatology .

Antibiotic treatment is the standard care for patients with uncomplicated acute diverticulitis. However, this practice is based on low-level evidence and has been challenged by findings from 2 randomized trials, which did not include a placebo group.

In the instant study the researchers enrolled 180 patients hospitalized for uncomplicated acute diverticulitis as determined by CT. The patients were randomly assigned to groups given antibiotics (n = 85) or placebo (n = 95) for 7 days. The researchers collected demographic, clinical, and laboratory data and answers to questionnaires completed every 12 hrs for the first 48 hrs and then daily until hospital discharge. The primary endpoint was length of hospital stay; secondary endpoints included occurrence of adverse events, readmission to the hospital, procedural intervention, change in serum markers of inflammation, and patient-reported pain scores at 12 and 24 hrs.

There was no significant difference in median time of hospital stay between the antibiotic group (40.0 hrs; 95% CI, 24.4–57.6 hrs) and the placebo group (45.8 hrs; 95% CI, 26.5–60.2 hrs) (P=.2). There were no significant differences between groups in adverse events (12% for both groups; P=1.0), readmission to the hospital within 1 week (6% for the placebo group vs 1% for the antibiotic group; P=.1), and readmission to the hospital within 30 days (6% for the placebo group vs 11% for the antibiotic group; P= .3).

The researchers concluded that

foregoing antibiotic treatment did not prolong length of hospital admission. This result provides strong evidence for omission of antibiotics for selected patients with uncomplicated acute diverticulitis.The placebo was noninferior to antibiotics for management of uncomplicated acute diverticulitis and said that decisions about antibiotic use in this population should be considered in the context of antibiotic resistance and stewardship. "Antibiotic use in uncomplicated acute diverticulitis has been identified as an area in which prescribing practices could change based on new evidence," they wrote. "Given that patients with diverticular disease continue to have high antibiotic exposure in the community, this potentially represents a significant reduction in unnecessary antibiotics.

For further reference log on to:

Jaung R, Nisbet S, Gosselink MP, et al. Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial [published online ahead of print, 2020 Mar 30]. Clin Gastroenterol Hepatol. 2020;S1542-3565(20)30426-2. doi:10.1016/j.cgh.2020.03.049