Antibiotics vs. placebo in acute uncomplicated diverticulitis


Background: Antibiotic therapy is considered the standard of care for acute uncomplicated diverticulitis. Over the past decade, randomized clinical trials have suggested that treatment with antibiotics may be noninferior to observation with supportive care; however, there have not been any blinded, placebo-controlled trials to provide high-quality evidence.

Dr. Ariel Y. Elyahu, division of hospital medicine, Mount Sinai Health System, New York

Dr. Ariel Y. Elyahu

Study design: Placebo-controlled, double-blinded, randomized noninferiority trial.

Setting: Four centers in New Zealand and Australia.

Synopsis: Researchers randomized 180 patients hospitalized for acute uncomplicated diverticulitis with Hinchey 1a CT findings (i.e., phlegmon without abscess) into two groups treated with either antibiotics (intravenous cefuroxime and oral metronidazole followed by oral amoxicillin/clavulanic acid) or placebo for 7 days. Median lengths of stay between the antibiotic (40.0 hours) and placebo (45.8 hours) groups were not significantly different (5.9 hours difference between groups; 95% CI, –3.7 to 15.5; P = .2). Additionally, there were no significant differences in the secondary outcomes of readmission at 7 days and 30 days or in need for procedural intervention, mortality, pain scores at 24 hours, or change in white blood cell count.

Notably, though this study was adequately powered to detect differences in length of stay, it was not powered to detect differences in clinical outcomes, including death or the need for surgery. The exclusion of patients with language barriers raises concerns regarding the generalizability of the results.

Bottom line: Antibiotic therapy does not decrease length of hospital stay when compared with placebo for patients with acute uncomplicated diverticulitis.

Citation: Jaung R et al. Antibiotics do not reduce length of hospital stay for uncomplicated diverticulitis in a pragmatic double-blind randomized trial. Clin Gastroenterol Hepatol. 2020 Mar;S1542-3565(20):30426-2. doi: 10.1016/j.cgh.2020.03.049.

Dr. Elyahu is a hospitalist in the Division of Hospital Medicine, Mount Sinai Health System, New York.

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